# The Intersection of Chronic Disease and Economic Hardship in Rural African American Communities

## TL;DR

This study explores how chronic diseases and economic hardship intersect in rural African American communities, showing how poverty worsens health outcomes.

## Contribution

The paper introduces a syndemic approach to better understand health disparities in rural African American populations.

## Key findings

- Higher syndemic scores correlate with fewer healthy behaviors like eating and physical activity.
- Qualitative themes highlight the 'chronicity of poverty' and its impact on health management.
- Limited economic resources lead to clustering of health complications, supporting syndemic theory.

## Abstract

Introduction Multiple chronic conditions disproportionately affect rural African Americans, who face higher prevalence and worse outcomes for arthritis, diabetes, and hypertension. Those living in challenging environments experience higher rates of chronic comorbidities due to the interactions between rural limitations and persistent structural factors. This research investigates using syndemic theory to forge new ground in rural minority health research. Methods Semi-structured interviews and photo-documentation were conducted among African Americans (mean age = 63.2, SD + 9.93 years) with long-term diabetes (mean diagnosis = 14.7, SD + 10.8 years) and hypertension (91.3%). Quantitative analysis included univariate and bivariate statistics describing demographics and self-management behaviors by composite score (0 – 6) counting depression, hypertension, arthritis, smoking, obesity, and poverty. Qualitative methods included semi-structured interviews, photo-documentation, thematic content analysis, and critical visual methodology. Triangulation occurred when photographic themes aligned with interview themes. Results Participants with higher syndemic scores (4.31, SD + 0.48) showed fewer days of healthy eating, physical activity, and glucose testing adherence. Qualitative analysis revealed two themes: “chronicity of poverty” and “contextual factors affecting health management.” Limited economic resources not only discouraged positive diabetes management but also triggered clustering of health complications, supporting syndemic theory that individuals with diabetes experience magnified health-related and socioenvironmental burdens. Discussion This syndemic approach provides a novel perspective for understanding contributing factors influencing health in rural African American communities. A comprehensive approach addressing biological and social elements is necessary to reduce disease burden, improve patient-centered care, and develop targeted programs supporting self-management practices in these communities.