Rural older adults, particularly those with Chronic Obstructive Pulmonary Disease (COPD), face significant risks to medical care during power outages caused by natural disasters. This cross-sectional study surveyed 222 Iowan adults aged 45-80 between March and May 2024 to assess disaster preparedness for power outages. Nearly nine in 10 participants experienced recent outages, yet 42% maintained a specific medical care plan for such events. Those with COPD exhibited moderately greater levels of preparedness, including higher rates of saving extra medication and establishing emergency communication plans. They were also twice as likely to have a care plan or emergency medication. Despite these gains, comprehensive preparedness remained low. The study highlights that recurrent disasters, such as windstorms and wildfire smoke, expose critical gaps in medical and emergency planning in rural communities. These results underscore the urgent need for tailored, disease-specific strategies and educational interventions to strengthen disaster resilience among rural populations.

Placental schistosomiasis (PS) is underdiagnosed and may compromise maternal and neonatal health. This study estimated the prevalence of PS in a rural Gabonese population of pregnant women with confirmed S. haematobium infection using light microscopy of macerated placental tissue. This is a cross-sectional, diagnostic proof-of-concept study which applied an improved placenta maceration technique in real-world conditions to diagnose PS. Performing light microscopic assessment of a single sample of 10 mL urine, we screened pregnant women for S. haematobium infection who sought antenatal care in Lambaréné (Gabon) between January 2022 and January 2023. Women positive for S. haematobium infection were followed up until delivery. Additionally, a subsample of women with negative urine samples was recruited as a non-infected control group (1:1 ratio infected and non-infected groups) and followed up until delivery. Only participants with available macerated placental samples were considered for final analysis. Placental samples were subjected to light-microscopy-based screening for S. haematobium eggs and PS was considered present if a least one S. haematobium egg was detected. Positive light microscopic placental samples were confirmed by qPCR. Among 318 women screened for S. haematobium in urine, we found 40 (12.6%; 95% CI: 9.1-16.7%) to be positive. Together with 40 women in the non-infected control group all women were followed up until delivery. After loss-to-follow-up, 28 (70%; 28/40) women with S. haematobium infection and 20 (50%; 20/40) without infection provided placenta samples at delivery. In the group with S. haematobium infection, 14% (4/28; 95% CI: 4.0-32.7%) of women were positive for S. haematobium eggs in macerated placenta tissue. In the non-infected control group, one woman (5%; 1/20; 95% CI: 0.1-24.9%) had a positive microscopy result for PS. All five women with positive S. haematobium egg microscopy in placental tissue received a concordant qPCR result. 14% of women with S. haematobium infection also had PS. Notably, PS was also observed in 5% of women without detectable S. haematobium eggs in urine. This suggests that PS could be an underestimated phenomenon in highly endemic regions and warrants further investigations of its implications for mother-and-child health.

To evaluate and synthesize the existing evidence on factors influencing the quality of life (QoL) of non-Hodgkin lymphoma (NHL) survivors and the impact of these factors on their QoL. A systematic review was conducted following PRISMA guidelines, with searches in CINAHL, MEDLINE, PubMed, ScienceDirect, Scopus, and Web of Science. Studies published between 2014 and 2025 were included if they were original English-language research involving adult (age≥ 18years) NHL survivors and focused on factors affecting QoL. Exclusion criteria encompassed animal studies and nonoriginal research. Data synthesis and quality assessment utilized the convergent integrated analysis framework from the Joanna Briggs Institute to identify key themes across studies. Nineteen studies (n = 8322) were included, revealing nine key themes: (1) personal characteristics (e.g., age and gender); (2) clinical characteristics (e.g., time since diagnosis and comorbidities); (3) physical concerns (e.g., fatigue and symptom burden); (4) psychological concerns (e.g., anxiety, depression, and PTG); (5) lifestyle factors (e.g., diet and exercise); (6) sexual health (e.g., satisfaction and erectile dysfunction); (7) economic status (e.g., employment and financial strain); (8) supporting systems (e.g., unmet needs), and (9) area of residence (e.g., rural residence). This review highlights the multifactorial influences on QoL in NHL survivors, emphasizing the need for integrated survivorship care that addresses physical, psychological, and social dimensions to improve long-term outcomes. Healthcare providers should prioritize individualized care plans addressing both physical and psychosocial challenges, with digital health interventions, especially for rural populations, to enhance QoL outcomes.

The authors examine the development of physical culture and sports in Soviet villages in the 1920s. These practices are important instruments of the cultural revolution, asthey were supposed to discipline and improve the health of peasants so that they could work as effectively as possible for the benefit of society. It was peasants themselves that made up most of the population, so the goal of “reforging” rural people was paramount; without it, the task of building socialism in the country would be impossible. To explore this topic, the author used regulatory, administrative, and statistical materials, stored in the State Archive of the Russian Federation, in the fund of the USSR Committee for Physical Culture and Sports (F. R 7576), and in the fund of the Central Committee of the All-Union Leninist Young Communist League (F. M 1) of the Russian State Archive of Socio-Political History, as well as various periodicals. It is shown that the rural population was highly distrustful of any innovations, including in physical culture. The analysis of sources reveals that the promotion of physical culture in rural areas began as part of the “Facing Village” policy of 1925-1926, with the primary goal being to “improve” physical and ideological health of rural people. The Komsomol shouldered the brunt of the practical work, employing a flexible approach that sought to motivate rather than coerce. The author reveals that the highest percentage of physical culture enthusiasts was in the central region part of Russia, whereas the lowest percentage was in the national republics and regions. The author concludes that, due to financial problems and lack of coordinated policy of all the agencies involved, progress in promoting physical culture in the rural areas by the end of the period was relatively insignificant; the number of physical culture clubs grew slowly, and they were often created spontaneously and lacked state oversight. In addition, there were few women involved, and the primary focus was on football rather than general physical training.

Background/Objectives: Cardiometabolic risk factor clustering is common in older adults and is associated with substantially increased cardiometabolic morbidity and mortality. This study aimed to examine the association between serum 25-hydroxyvitamin D [25(OH)D] status and cardiometabolic risk factor clustering among rural community-dwelling older adults. Methods: This cross-sectional study analyzed data from the 2022 Korea National Health and Nutrition Examination Survey (KNHANES) for 432 adults aged ≥65 years residing in rural areas. Cardiometabolic risk factor clustering was defined as the presence of ≥2 of the following: abdominal obesity, hypertension, type 2 diabetes mellitus, and dyslipidemia. Multivariable logistic regression was performed adjusting for sociodemographic and behavioral factors. Results: Cardiometabolic risk factor clustering was more prevalent among participants with vitamin D deficiency (<15 ng/mL) than among those with sufficient levels (66.0% vs. 44.9%, p = 0.006). After adjustment, vitamin D sufficiency (≥15 ng/mL), compared with vitamin D deficiency (<15 ng/mL), was associated with lower odds of clustering (aOR = 0.422, 95% CI: 0.219–0.811, p = 0.010). Meeting the WHO physical activity guideline was also associated with lower odds of clustering (AOR = 0.450, 95% CI: 0.226–0.897, p = 0.023). Conclusions: Lower vitamin D status was associated with a higher prevalence of cardiometabolic risk factor clustering. These findings support the consideration of vitamin D assessment and lifestyle-focused strategies within community health nursing practice to reduce cardiometabolic risk in rural aging populations.

Every year, crashes in rural towns take lives and alter the dynamics of entire communities. This research seeks to understand a broad scope of factors that determine the severity of crashes that produce either severe or fatal results, specifically in and around the region of Texas known as the “Piney Woods.” In the past 10 years, the Piney Woods has accounted for over half of the rural population crashes in the state of Texas, provoking specific interest in understanding the influencing factors of the crashes that produce severe and fatal injuries in this region. Therefore, to better understand these contributing factors, we extracted data from the Texas Department of Transportation Crash Record Information System database, which were then further split into a training and a test data set. Then, five machine learning techniques, namely binary logistic regression, k-nearest neighbors, naïve Bayes, random forest, and an artificial neural network, were applied to the unseen test data. The random forest model produced the most promising results by predicting nonsevere crashes with 99.5% accuracy. The results of this research afford engineers and industry practitioners a greater understanding of the factors that influence crashes, specifically severe crashes, within the Piney Woods. This random forest model could be used along with the readily available input parameters to predict roadways and intersections that might yield severe crashes in the future.

Assessing exposure inequity to heatwaves between urban and rural populations across 18 Asian countries in a warmer climate

Housing distance, salt intake and cardiovascular risk in rural Aceh Tamiang: Insights utilizing the WHO 10-year non-laboratory assessment.

Regional variation in maternal RSV vaccine access and attitudes across two California cohorts.

Given the potential of organochlorine pesticides (OCPs) to disrupt metabolic health, we aimed to explore their association with obesity and to explore the potential bidirectional mediating relationships involving metabolic health indicators among 894 rural Chinese adults with prediabetes. A total of 894 individuals were included in this cross-sectional study. The associations of plasma OCPs on obesity and obese anthropometric measurements were assessed by generalized linear regression models for single exposure, and quantile g-computation (QGC) and LASSO regression for mixed exposure. The potential contributions of multiple health indicators to observed associations were assessed through mediation analysis. Exploratory bidirectional mediation analysis was employed to assess two potential pathways: (1) whether metabolic health indicators mediate the association between OCP exposure and obesity, and (2) whether obesity mediates the relationship between OCP exposure and metabolic health indicators. We discovered that β-Benzene hexachloride (β-BHC) and p,p'-Dichlorodiphenyldichloroethylene (p,p'-DDE) were related to obesity for single exposure. QGC and LASSO demonstrated that OCPs were positively correlated with a higher likelihood of obesity for mixed exposure, with β-BHC being the primary contributor. Exploratory mediation analysis found that obesity and metabolic-related indicators play a bidirectional mediating role in the association with OCPs, mainly involving systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TG), high-density lipoprotein-Cholesterol (HDL-C), low-density lipoprotein-Cholesterol (LDL-C), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase/alanine aminotransferase (AST/ALT). In this cross-sectional study, we found that OCPs exposure may increase obesity risk both directly and by disrupting metabolism, while obesity itself can worsen OCP-related metabolic damage, revealing a bidirectional environment-body interaction.

Cardiovascular disease constitutes the most formidable public health challenge in China, accounting for 48.98% and 47.35% of mortality in rural and urban populations, respectively, affecting approximately 330million individuals. Existing risk stratification models predominantly derive from Western populations, with the Framingham Risk Equation systematically overestimating cardiovascular risk by 276% in Chinese men and 102% in Chinese women, underscoring the critical imperative for population-specific predictive instruments. Although machine learning methodologies demonstrate considerable promise in cardiovascular risk prognostication, their inherent "black-box" characteristics substantially impede clinical translational implementation. Leveraging longitudinal cohort data from the China Health and Retirement Longitudinal Study (CHARLS) and integrating machine learning with explainable artificial intelligence techniques, we sought to develop and validate a cardiovascular disease long-term risk prediction model tailored to the Chinese middle-aged and elderly population, achieving optimal synthesis of predictive accuracy and clinical interpretability through quantitative risk factor contribution analysis. We incorporated four waves of CHARLS surveillance data spanning 2011-2020, with 8,080 participants aged ≥ 45 years completing 9-year follow-up after rigorous inclusion criteria application. Recursive feature elimination was employed to identify optimal predictors from 90 candidate variables. We systematically evaluated 12 machine learning algorithms encompassing linear, non-linear, ensemble learning, and deep learning methodologies, utilizing stratified random 7:3 partitioning for training and validation cohorts. SHAP (SHapley Additive exPlanations) methodology facilitated comprehensive global and local interpretability analyses, with decision curve analysis assessing clinical net benefit. Among 5,699 training cohort participants, 1,248 (21.9%) experienced cardiovascular events during follow-up. Recursive feature elimination identified 18 pivotal predictive factors spanning lipid metabolism, anthropometric parameters, renal function, and glucose homeostasis domains. The gradient boosting machine demonstrated superior comprehensive performance, achieving validation cohort AUC of 0.798 (95% CI: 0.776-0.820), specificity of 98%, and positive predictive value of 78%. SHAP analysis revealed waist circumference, triglycerides, and hypertension history as the three predominant predictive factors, with mean absolute SHAP values significantly exceeding other variables. Individual risk attribution analysis demonstrated substantial heterogeneity: extremely high-risk specimens (predicted probability 0.991) exhibited synergistic multi-factorial risk amplification, with standardized waist circumference contributing + 0.0778 SHAP value and triglycerides (477mg/dL) contributing + 0.0729; conversely, low-risk specimens (predicted probability - 0.0393) demonstrated triglycerides (45.1mg/dL) providing the maximal singular protective contribution of -0.166. Decision curve analysis confirmed positive net benefit across the 0-0.95 threshold probability spectrum, systematically surpassing conventional strategies. The gradient boosting machine model achieved superior discrimination (AUC 0.798, 95% CI 0.785-0.825) compared to Framingham (0.638) and China-PAR (0.654) scores for 9-year cardiovascular disease prediction in Chinese adults aged ≥ 45 years. Waist circumference, triglycerides, and hypertension emerged as principal predictive features, though SHAP-derived importance reflects statistical contribution rather than causal effects. Decision curve analysis demonstrated clinical utility across threshold probabilities 0.05-0.95, enabling flexible deployment from population screening (98.3% sensitivity) to targeted intervention (98.7% specificity). External validation in independent cohorts is essential to establish generalizability before clinical implementation. Not applicable.

Patient portals are designed to improve transparency, engagement, and satisfaction with health care. However, disparities in access and encouragement to use portals persist, and their relationship with perceived care quality is not well understood. Authors of this study examined whether being offered access to a patient portal, and being encouraged to use it, were associated with higher perceived quality of care among United States adults. The authors analyzed data from the 2024 Health Information National Trends Survey 7 (HINT 7), a nationally representative cross-section of United States adults aged ≥18 years. Weighted analyses assessed associations between portal access offers, encouragement, and self-rated care quality in the past 12 months, adjusting for sociodemographic characteristics. Among 7,278 respondents (mean [SD] age, 49.0 [18.0] years), 78.6% rated their care as good, very good, or excellent. Overall, 73% had portal access and 69.0% were encouraged to use a portal. The number of respondents offered access to patient portal was significantly lower among older adults ≥75 years (10.6%; χ2 8=108.2, p <0.0001), women (27.9%; χ2 4=31.7, p <0.0001), those with lower income (8.3%; χ2 10=158.0, p <0.0001) or education (13.6%; χ2 6=107.9, p <0.0001), and rural residents (10.0%; χ2 2=12.1, p = 0.0024). In adjusted analyses, being offered portal access was associated with higher odds of rating care as excellent (aOR 2.47, 95% CI 1.21-5.07). Being offered portal access independently was associated with higher perceived care quality. Addressing disparities in portal access; especially among older, lower-income, and rural populations; may improve equity in patient experience.

This study investigated whether serum 25-hydroxyvitamin D (25(OH)D) modifies the association between meeting WHO aerobic physical activity guidelines and cardiometabolic risk clustering among rural older adults in South Korea. This cross-sectional study analyzed 2023 Korea National Health and Nutrition Examination Survey (KNHANES) data for rural-dwelling adults aged ≥65 years with complete data (n = 441). Cardiometabolic risk clustering (CMRC) was defined as the presence of ≥3 of five risk factors (abdominal obesity, elevated blood pressure, low HDL-cholesterol, elevated triglycerides, and hyperglycemia). Exposures were continuous serum 25-hydroxyvitamin D (25(OH)D) and adherence to the WHO aerobic physical activity guidelines (yes/no). Multivariable logistic regression models tested the 25(OH)D × physical activity interaction, adjusting for sex, age (≥75 vs. <75 years), education, household income, smoking status, alcohol use, and obesity (BMI ≥ 25 kg/m2). Conditional effects of physical activity were estimated at the 16th, 50th, and 84th percentiles of 25(OH)D. A significant interaction between 25(OH)D and physical activity was observed (OR = 0.91, 95% CI: 0.85-0.97; p = 0.005). Physical activity was not associated with CMRC at low 25(OH)D (16th percentile, 17.08 ng/mL; OR = 1.64, 95% CI: 0.78-3.47), but it was associated with lower odds of CMRC at high 25(OH)D (84th percentile, 36.98 ng/mL; OR = 0.25, 95% CI: 0.10-0.62). Vitamin D status modified the association between aerobic physical activity and cardiometabolic risk clustering among rural older adults. Integrated prevention strategies addressing both physical activity and vitamin D insufficiency may be valuable in rural aging populations.

Agriculture is essential to food security and rural development in emerging economies, as it provides livelihoods for over 70% of the rural population, especially in areas like South Asia and Sub-Saharan Africa. However, efforts to enhance agricultural productivity have been hindered by multiple interlinked factors, including economic instability, unequal land distribution, increasing climate variability, and the limited dissemination of scientific knowledge and improved planting methods among farmers. Despite the fact that agriculture is rapidly changing technologically thanks to Agriculture 4.0 and the new Agriculture 5.0 paradigm, many rural and resource-constrained areas have not yet embraced these innovations because of their high costs, poor infrastructure, and lack of technical capacity. Organizations like the Food and Agriculture Organization (FAO) have promoted a balanced strategy that incorporates social justice, environmental preservation, and productivity in response to these issues, and the idea of sustainable agriculture has been widely recognized. Sustainable agricultural methods have been clearly beneficial to industrialized farming systems since the 1990s, but for successful global application, both large-scale commercial farms and smallholder systems in poor nations still need focused, site-specific study. Through the promotion of diverse cropping systems, design-oriented spatial planning, and efficient resource flows, climate-smart agriculture (CSA) helps conserve biodiversity by enhancing ecosystem resilience and lowering climate-related risks. The shift to climate-smart, circular agricultural systems is further supported by the integration of spatiotemporal, data-driven sensing, monitoring, and decision support frameworks, which allows for optimal resource usage.

This study investigates disparities in the utilization of primary health care (PHC) between urban and rural populations in Indonesia, focusing on socioeconomic and demographic determinants. Understanding these patterns is essential for promoting equity under the National Health Insurance (Jaminan Kesehatan Nasional, JKN) program. Data were obtained from the 2023 National Socioeconomic Survey, which included 334,887 individuals. Binary logistic regression was used to examine the association between individual characteristics and PHC utilization. Overall utilization rates were similar across urban and rural areas, but significant disparities were observed. Women were more likely to use PHC than men (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.10-1.13). The association between higher education and PHC utilization was negative (OR, 0.78; 95% CI, 0.75-0.81), while access to information technology slightly reduced utilization (OR, 0.98; 95% CI, 0.96-0.99). Wealth effects diverged sharply: affluent urban residents were less likely to use PHC (OR, 0.84; 95% CI, 0.81-0.87), whereas wealthier rural residents were more likely to utilize PHC (OR, 1.09; 95% CI, 1.05-1.13). Dual insurance ownership had a strong positive effect in rural areas (OR, 1.56; 95% CI, 1.25-1.94). Conclusion: These findings highlight structural inequalities in PHC utilization. Policy efforts must prioritize enhancing the quality and attractiveness of PHC in urban areas, improving financial protection and infrastructure in rural areas, and addressing the digital divide. Such targeted measures are essential for achieving equitable and inclusive health coverage under JKN.

Pesticide self-poisoning accounts for 14%-20% of global suicides. South Korea banned paraquat and eight insecticides commonly involved in suicide in 2011-2012. We investigated the longer-term (2013-2019) impact of the pesticide bans on reducing suicides in South Korea. Suicide data by sex, age, area and method among people aged 15 years or above were extracted from registered death data (1997-2019). Data for suicide by self-poisoning using different categories of pesticides (herbicides and fungicides; insecticides; rodenticides and other pesticides; and unspecified pesticides) were also extracted. Segmented regression analyses were used to estimate step (level) changes in pesticide suicide rate in 2012 (ie, the intervention period) and 2013-2019 (ie, the post-intervention period) as well as the slope (trend) changes in pesticide suicide trends in 2013-2019 (vs the 2003-2011 pre-intervention period). The bans on paraquat and eight insecticides (2011-2012) were followed by a 15% reduction in pesticide suicide rates in 2012 and a further 36% reduction in 2013, accompanied by an additional 6% annual decline in trend in 2013-2019 versus 2003-2011, with an estimated 8353 pesticide suicides averted (2012-2019). The reduction was mainly found in males, older people aged 70+ and rural populations. The greatest impact was found in suicides involving herbicides and fungicides (including paraquat) and insecticides across the categories of pesticides. No evidence was found for a shift to other poisoning suicides or an impact on agricultural yields of the pesticide bans. South Korea's pesticide bans in 2011-2012 were followed by a sustained decrease in pesticide suicides in the 7-year period (2013-2019) after their implementation. National policies restricting or banning highly hazardous pesticides commonly involved in self-poisoning can prevent many suicide deaths over a sustained period. Additional regulatory efforts could further reduce these unnecessary premature deaths.

Vasculitis often poses a significant burden on individuals, their families and the health care system. Understanding its epidemiology can aid in facilitating timely interventions. We present a province-wide population study comparing the 1) incidence of vasculitis amongst farmers, rural-non farmers and urban residents, 2) the use of health services and 3) all-cause mortality rates across the three cohorts. The groups were randomly selected on the basis of provincial health data.Criteria for ascertaining vasculitis cases included either one hospital admission, two physician visits within a 2-year interval, or two ambulatory care visits within 2years related to the vasculitis diagnosis. Descriptive statistics were used to compare the incidence rates. A total sample size of 302,089, with 5437 vasculitis cases. Farmers had the highest incidence of all types of vasculitis (109.8/100,000 person-years (PY)), followed by rural non-farmers (93.1/100,000 PY) and urbanites (71.7/100,000 PY). Age at diagnosis was higher among farmers (66.2years) compared to rural non-farmers (64.5years) and urbanites (63.9years). Polymyalgia rheumatica (PMR) accounted for 47% of cases, followed by Arteritis Unspecified (15%) and small-vessel vasculitis (14%). Within the farming population, a higher percentage of males had positive cases of vasculitis compared to other populations. Rural non-farmer population had the highest use of health care services and unadjusted non-injury mortality rate (31.8/100,000 PY), followed by rural farmers (25.4/100,000 PY) and urban residents (23.8/100,000 PY). Our province-wide study revealed that farmers face the highest incidence rates of vasculitis as well asthe second highest burden of disease in terms of healthcare service needs and mortality. Key PointsAQ • There is a notable variation in the incidence rates of vasculitis among farmers, rural and urban residents with the farming population showing the highest incidence rate across most subtypes of vasculitis. • Farmers had a greater percentage of males diagnosed with vasculitis and an older age at diagnosis. • Rural non-farming patients with vasculitis demonstrate the highest utilization of healthcare services and mortality.

Urban-rural differences in the longitudinal reciprocal relationship between assets and health among Chinese older adults.

Background: In the past, Hepatitis B virus (HB) was menace to mankind and was considered a serious global health burden. WHO reported that, HB resulted in an estimated 1.1 million deaths in 2022, mostly from cirrhosis and hepatocellular carcinoma, it could have been prevented by vaccines that are safe, available and effective. Despite the availability of vaccine, 61 million people are reported to be infected in the South-East Asia Region. Many studies have been conducted in Bangladesh but these focused on risk groups such blood donors, Rohingya migrants, health professionals. The aim of this study was to determine the prevalence of hepatitis B and C virus infection among the secondary school children of rural Bangladesh. Methods: This was a cross-sectional study and was conducted from May and June 2024. Three secondary schools of two upazilas were purposively selected, one girl and two boys. All participants were selected randomly from six to ten classes. The participants were tested for hepatitis B virus surface antigen (HBsAg) and anti-HCV using enzyme linked immunosorbent assay (ELISA). The investigations included height, weight, waist and hip girth, body mass index (BMI), waist-to-hip ratio and waist-to-height ratio, as well as blood pressure (BP), fasting blood glucose (FBG) and serum glutamic-pyruvic transaminase (SGPT). Results: Two hundred and fifty students (boys / girls = 165 / 85) participated in three secondary schools. The biophysical characteristics were assessed (mean ± SD, 95% CI) and found that the boys had significantly higher general obesity (BMI P&lt;0.001); central obesity (WHR p&lt;0.001, WHtR p&lt;0.001). The values for FBG (p=0.045) and DBP (p&lt;0.001) were significantly higher in girls than among boys. The prevalence of hepatitis B virus (HBV) was found 0.4% among the secondary school students in this study. No hepatitis C virus (HCV) was detected. Conclusion: The prevalence of HBV was 0.4% and the absence of HCV among secondary school children in rural areas indicates a decline compared to the previous studies. This trend suggests that vaccination coverage for HBV in the rural population has been satisfactorily achieved. The study finding also suggest that elimination of this disease is highly possible. BIRDEM Med J 2026; 16(1): 14-18

Abstract Background: Breast cancer remains a leading health concern among women, with Estrogen Receptor (ER) status influencing prognosis and treatment. Rural populations often face disparities in access and outcomes, yet data remains limited. This study evaluates the relationship between Body Mass Index (BMI), demographics, and ER status in breast cancer patients from Southeast Alabama. By analyzing a large rural cohort, we highlight how elevated BMI, type 2 diabetes, tobacco use, race, and family history may influence ER(+) disease, offering insights that may guide future preventive strategies and targeted screening efforts in underserved communities. Methods: We reviewed data from July 2018 to June 2025 using our institution’s Epic database, SLICER DICER. BMI was categorized according to the World Health Organization (WHO) adult classification. International Classification of Disease (ICD) codes were used to extract data from Slicer Dicer. The study population (n=1421) consisted of individuals from rural communities in Southeast Alabama. Results: Comparisons were made between ER(+) breast cancer and ER(-) breast cancer in adult BMI classifications per WHO. Average age for ER(+) breast cancer was 70.1+.7 years and average age for ER(-) breast cancer was 73.1+.7 years. The ER(+) population was 70.9% white, 26.6% black, and 2.5% other. The ER(-) population was 62% white, 37.1% black, and 0.9% other. Comparisons between BMI for ER(+) vs ER(-) breast cancer respectively; BMI less than 18.5 was 2.67% vs 2.83%; BMI 18.5-25, 18.08% vs 17.56%; BMI 25-30, 29.34% vs 26.91%; BMI 30-35, 24.34% vs 25.5%, BMI 35-40, 15.62% vs 17%. Comparison with respect to Type 2 Diabetes Mellitus diagnosis for ER(+) vs ER(-) breast cancer respectively was 31%+3.2% vs 30.4+6.7%. Comparison with respect to positive family history for ER(+) vs ER(-) breast cancer respectively was 30.9%+3.3% vs 36.5%+7%. The comparison of tobacco use with respect to ER (+) vs ER(-) breast cancer was 40.1%+3.4% vs 40.9%+7.2%. Analysis using χ2 test (χ2=889.32) with p&amp;lt;.001 showed that there is an association between BMI and developing breast cancer. Conclusion: In this large rural cohort, elevated BMI, type 2 diabetes, and tobacco use were significantly associated with ER(+) breast cancer (p&amp;lt;.001). White patients were more likely to have ER(+) breast cancer (p&amp;lt;.001 OR=1.6) at our institution. Black women are more likely to have ER(-) breast cancer (p&amp;lt;.001 OR=1.5). The obesity prevalence in post- menopausal women in our population (54%) surpasses national prevalence of obesity in post-menopausal women (43%) per National Institute of Health (NIH), highlighting a critical regional disparity. Our findings suggest that modifiable metabolic and lifestyle factors may contribute to increased ER(+) breast cancer risk in underserved communities. Patients may benefit from further emphasis being placed on metabolic health and early intervention to address prevention. This also brings into light the lack of access to metabolic care in the area. These results underscore the need for future studies and public health initiatives focused on prevention, early detection, and risk stratification tailored to rural populations. Citation Format: N. Thotli, R. Bandarnaike, S. Valasareddi. A Retrospective Review of Demographics and BMI on ER Positive and Negative Breast Cancer in Rural Southeast Alabama [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-11-30.