PURE - Prospective Urban and Rural Epidemiological Study


Led by co-investigators Drs. Salim Yusuf and Koon Teo at McMaster University in Hamilton, this is the largest global study looking at environmental, societal and biological influences on obesity and chronic health conditions such as heart disease, diabetes and cancer. The PURE Study consists of over 150,000 participants from 17 countries of low, middle and high income. The CoHeaRT group is one of 4 centres within Canada that are taking part in the study, following 2,754 participants from areas of Vancouver, Burnaby, Surrey, Pitt Meadows and Bowen Island.


Developed countries in the 20th century experienced marked decreases in deaths from infections and childhood diseases while seeing increases in chronic non-communicable diseases such as obesity, diabetes, and cardiovascular disease. With the continued urbanization of developing countries, it is expected that the majority of global cardiovascular disease will shift to low- and mid-income countries while remaining a burden in high-income countries. Understanding the influences on cardiovascular risk factors in a community or the susceptibility of a community to cardiovascular disease is therefore important.


1. Cross-sectional component: to examine the relationship between societal influences and prevalence of risk factors and chronic non-communicable diseases measured at baseline. Societal determinants include 4 domains of interest: built environment, food and nutrition policy, psychosocial/socioeconomic factors, and tobacco.

2. Cohort component: to examine the relationship between societal determinants, incidence of chronic non-communicable disease events and changes in rates of selected risk factors (eg, smoking).


The PURE study recruited a total of 153,996 adults aged 35 to 70 years between 2003 and 2009 from urban and rural communities in low-, middle-, and high-income regions of the world. National, community, household and individual-level data were collected during this time.

National level data included information on policy and economic indicators that influence health, from sources such as the national census.

Community level data was collected using 1) the Environmental Profile of a Community's Health (EPOCH) Instrument, 2) the Neighbourhood Walkability Scale questionnaire administered to a household representative 3) participant data collected from select questions in the administered individual or household questionnaires. The EPOCH tool measured the built, nutritional, social and tobacco environments of communities, with a direct community observation component completed by researchers, and a participant interview component looking at the awareness, attitudes and social norms related to these community features.

Household and individual data were collected in the form of participant questionnaires, with individuals additionally undergoing a physical assessment consisting of blood pressure, anthropometric measures (weight, height, waist and hip), body fat percentage (BIA and DEXA measures), spirometry, electrocardiogram, a fasting blood sample and urine sample.

Participants will be followed for a total of 12 years, with telephone contacts occurring annually and reassessments occurring every 3 years.

Progress to Date

We are currently completing follow-up assessments for the 9th year of the study and beginning the next round of follow-up assessments.


See publications list