Grant: Foundation Grant

<html> <body> <p>The <strong>overarching focus</strong> of the Prospective Urban Rural Epidemiology (PURE) <strong>program</strong> is to 1) understand why cardiovascular disease (CVD) and other non-communicable disease (NCDs: diabetes, cancers, kidney and lung diseases) incidence and mortality vary substantially between <em>people</em> in different countries, communities, with different ethnic and social backgrounds ; 2) understand how the <em>environment</em> influences health behaviours, risk factors, CVD and NCDs (the "<em>causes of the causes</em>"); and 3) to relate variations in <em>health systems</em> in 26 countries and 800 communities on prevention, treatments, incidence and mortality from CVD and NCDs. By <strong><em>combining information across these 3 levels of influences</em></strong><em>, from 5 continents, on multiple diseases and using several complementary lines of investigation</em> (clinical medicine, epidemiology, environmental geography, chemistry, lab medicine, genetics, metabolomics, health systems, policy and statistics), <strong>PURE will provide an unprecedented degree of understanding into the causes and consequences of variations in CVD and other NCDs across several populations</strong>. PURE will also form a <em>platform</em> to understand how certain processes (multi-system dys-regulation, frailty, and social vulnerability; correlated with biochemical and genetic changes, e.g. telomere shortening or mosaicism) of <em>aging</em> are influenced by health behaviours, risk factors and the environment, and how they vary between societies and cultures.<br> <br>We will follow 270,000 individuals from 800 communities in 26 countries for a mean of ten years. We will examine how <em>individual level exposures and risk factors</em> (health behaviours, risk factors, analyses of stored bloods and urine and physical measures such as adiposity, lung function, strength and BP) are influenced by the <em>community</em> <em>environment</em> (tobacco, food, built, air quality and socioeconomic environments); and how the two together affect NCDs. By collecting new information on <em>health systems</em>, we will relate it to contrasting patterns of CVD and other NCDs, and try to explain some paradoxical observations (e.g. higher CVD risk factors, but lower CVD events and mortality in high income countries but the reverse in low income countries) and develop an integrated model of different levels of determinants that influence health. Although <em>our <strong>focus</strong> is in the CIHR priority area of <strong>global health and CVD</strong>, PURE will generate information on several NCDs that is <strong>relevant to the multi-ethnic population of Canada</strong></em><strong>.</strong> The greater range of exposures (individual risk factors, behaviours and environment) that can only be obtained from a study involving different countries, will enable <em>better characterization of what is &ldquo;normal&rdquo; versus &ldquo;abnormal&rdquo; for individuals and for communities, across several countries, including in <strong>Canada</strong>.</em> Our <strong>trans-disciplinary</strong> <strong>global team</strong> of experts and consultants and the <strong>unique design of PURE</strong>, will enable answering several important questions reliably. We combine this with a <em>successful and integrated mentorship and training program</em> that is both local (within institutions) and international (across institutions) and is expected to develop the careers of &gt;100 trainees and emerging faculty.<br> <br>PURE has already impacted international guidelines, policy and recommendations. It is expected that future discoveries will enable more precise measurement of the Global burden of Disease and influence prevention and treatment of CVD and other NCDs, and related health policy in Canada and globally.</p> </body> </html>