Heart disease is rampant in parts of the rural South. Researchers are hitting the road to learn why

Darrell Dixon’s father was just 25 when he suffered a massive heart attack in the rural Mississippi Delta. In his early 40s, a series of additional attacks had left his heart muscle too weak to pump enough blood to his body. He died in 2013 at age 49.

“It was a big shock for our family,” Dixon, 36, recalled. “For me personally, it also made me think about genetics. I just wondered if I was next.”

Dixon’s death prompted him to participate in an unusual and ambitious new health study.

Public health experts from some of the nation’s leading research institutions have deployed a massive medical trailer to rural parts of the South to test and study thousands of local residents. The goal: to understand why rates of heart and lung disease there are dramatically higher than in other parts of the U.S.

“This health disadvantage in rural areas, it doesn’t matter if you’re white or black, it hurts you,” said Dr. Vasan Ramachandran, a leader of the project who previously oversaw the Framingham Heart Study — the nation’s longest-running study on heart disease. “No race is spared, though people of color fare worse.”

The researchers plan to test the heart and lung function of about 4,600 residents of 10 counties and parishes in Alabama, Kentucky, Louisiana and Mississippi, while collecting information about their environment, medical history and lifestyle. They will also give participants a fitness tracker and plan to interview them repeatedly over the course of several years to check for major medical events.

Ramachandran, now dean of the University of Texas School of Public Health in San Antonio, said rural populations in the U.S. rarely get such personalized, sustained attention from epidemiologists. More than a dozen institutions are helping with the research, including Johns Hopkins University, the University of California, Berkeley and Duke University.

The 52-foot-long (16-meter-long), 27-ton trailer is equipped with instruments that examine calcium in the arteries, the structure of the heart, lung capacity and other more general health indicators such as blood pressure and weight. The initial exam can take more than three hours.

“They’re reaching out to the community and going out into the community in ways that I’ve never seen before,” said Lynn Spruill, mayor of Starkville, Mississippi, in Oktibbeha County, where the trailer arrived in 2022 and medical workers tested more than 700 people.

To research And facts US health officials say rural populations in the US unhealthier and have lower life expectancies than Americans in urban areas. The health disparities are even greater in the South, where death rates from heart disease — the leading cause of death in the U.S. — are more than double the national average for people 35 and older in some rural communities. Lung conditions such as chronic obstructive pulmonary disease, or COPD, which the study also examines, are also more common in the South.

Researchers have multiple theories about the disparity. Hospital closures and physician shortages have left many rural residents with limited access to care. Healthy food, fitness facilities and public transportation are often scarcer. Poverty rates are higher and fewer people receive health insurance through their employers. In the rural South, poverty rates and the share of people without health insurance are even higher.

Smoking is a major cause of heart disease and At least 20% of adults smoked in Alabama, Kentucky, Louisiana and MississippiAccording to 2019 data from the U.S. Centers for Disease Control and Prevention. Obesity is another factor. In 2022, self-reported height and weight caused between 38% and 40% of adults in the four states in the Body Mass Index (BMI) category for obesity.

By closely examining local residents and their environments, the Rural Study seeks clearer answers to the question of what is driving the additional health burden in the South. Researchers also want to understand what makes some rural districts there much healthier than others.

“We’re interested in both the risk and the resilience,” said Lindsay Pool, an epidemiologist at the National Heart Lung and Blood Institute, which has awarded more than $40 million for the study.

To achieve that goal, researchers are also visiting rural areas with a low risk of heart and lung disease in three of the states — Louisiana, Mississippi and Kentucky — despite similar demographics.

Oktibbeha County, home to Mississippi State University, in eastern Mississippi near the Alabama border, is the low-risk location. The researchers compare it to Panola County in northern Mississippi, about 60 miles (97 kilometers) south of Memphis, Tennessee.

Both counties have poverty rates above 20% and a similar and significant share of people under 65 without health insurance. But between 2019 and 2021, the heart disease death rate for people 35 and older was 647 per 100,000 people in Panola County, compared with 395 per 100,000 in Oktibbeha County, according to CDC data.

In more urban Rankin County, Mississippi, which is part of the Jackson metropolitan area, the figure was 331. The U.S. average over the same period was 326.

Dixon, who works in Panola County for a regional development organization and serves as a consultant for the heart and lung study, helped recruit more than 600 Panola County residents for the project. Heart disease is so common there that it’s common to hear people talking about their medications and side effects in local stores and churches, he said.

Dixon’s father, Darrell Dixon Sr., lived in Clarksdale, about 40 miles (64 kilometers) west of Panola County. He had long suffered from high blood pressure and had a strong family history of heart disease.

He suffered another massive heart attack after an inmate he had bonded with as a chaplain at the Mississippi State Penitentiary was executed, Dixon said. He spent the last years of his life in the hospital with congestive heart failure.

“He really suffered,” Dixon said. He hopes the study will shed light on unseen environmental factors that may have played a role in his father’s death and raise awareness among local residents about “how to live better.”

The trailer is now in Franklin Parish in northeastern Louisiana, where the heart disease death rate was a whopping 859 per 100,000 people for people 35 and older between 2019 and 2021, according to CDC data. About 200 miles (322 kilometers) to the south in New Orleans, it was 340.

The National Heart, Lung and Blood Institute plans to extend the study through 2031, and researchers hope to re-examine all participants in person at that time.

“The longer you can follow people, the better you can understand the development and progression of diseases,” said Pool, the epidemiologist.