Sedentary behavior and physical health status explain the relationship between years of residence in socioeconomically distressed counties and risk for Cardiovascular diseases

Background

Residents of rural, socioeconomically distressed counties,such as Appalachian Kentucky, experience disproportionately high cardiovascular disease (CVD) risk, compounded by sedentary behavior and poor self-reported physical health.

Objectives

This study investigates whether sedentary behavior and poor self-reported physical health serially mediate the relationship between years of residence in rural Appalachian Kentucky counties and CVD risk.

Methods

This secondary analysis included 309 adults residing in rural Appalachian counties. Sedentary behavior was measured as daily minutes in sedentary activity using an Actiwatch. Self-reported physical health was assessed using the Short-Form Health Survey-12, and CVD risk was measured using the Framingham risk score. Serial mediation analysis with two mediators was conducted using the PROCESS macro, controlling sociodemographic and lifestyle covariates.

Results

The participants’ mean age was 57.3 (±15) years, with an average residence duration of 42.7 (±22.2) years. Participants spent an average of 751.6 (±215.3) minutes per day in sedentary behavior, and the mean CVD risk was 15.3% (±10.4%). Years of residence were directly associated with increased CVD risk (direct effect = 0.168; 95% Boot CI [.117, 0.219]) and indirectly associated through sedentary behavior (indirect effect = 0.016; 95% Boot CI [.006, 0.039]). An additional indirect effect emerged through sedentary behavior leading to poorer self-reported physical health (indirect effect = 0.002; 95% Boot CI [.001, 0.004]).

Conclusion

These findings indicate that interventions targeting CVD risk reduction in rural socioeconomically distressed counties should include strategies to reduce sedentary behavior, which may improve self-reported physical health status and decrease CVD risk.