Abstract P137: Updated Trends in CVD Risk Factors and Rurality in Appalachian Children using Surveillance, Clustered Statistical Design and GIS Capabilities

Abstract

Research suggests a link between rurality and CVD risk factors; however, our previous work found that metropolitan (rather than rural) areas were associated with CVD risk factors in WV fifth grade children. Our goal is to examine developmental trends as well as updated CVD risk factors stratified by Rural-Urban Continuum Code (RUCC) classification. Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) data include 14,226 Kindergarten, 10,784 Second grade, 80,635 Fifth grade, and 1,451 Teenage children. The clustered analytic design nested children’s results within zip code using a six-category RUCC (Figure 1), and controlling for age, gender, race, and maternal education. Least squares means are reported. Outcomes included BMI percent above ideal (BMI%) for all grades, and HDL, LDL, and SBP for fifth grade. Developmental Trends: Kindergarten: Significant effect of RUCC on BMI%, p<0.0001, Metro (M=10.11) and Town (10.43) had higher means than Rural (6.66). Second grade: Metro (16.82) and Town (16.41) had higher means than Small Metro (12.48), Rural (10.48; p< 0.0001). Fifth grade: Metro (21.5) and Town (21.5) had higher means than Large Metro (17.78), Small Metro (17.86; p0.05). CVD Risk Factors: Metro (49.31), Non-metro Urban (49.28), and Town (49.76) had lower HDL than Large Metro (M=52.9), Rural (52.54) and Small Metro (51.36; p<0.05). Metro (95.76) presented with higher LDL than Rural (89.11), Town (90.25), Large Metro (91.08), Small Metro (91.28) and Non-metro Urban (91.8; p<0.05). Large Metro (108.97), Metro (109.03) and Town (108.76) had higher SBP than Rural (106.95) and Small Metro (107.28; p<0.05) Results suggest that younger children from rural areas had lower BMI% than metro and town areas. This trend appears to reverse as children enter middle and high school. Examination of fifth grade CVD risks found mid-sized metro areas presented with the worst outcomes.