David Hollar

Infant mortality rates (IMR) and other health disparities (e.g., low provider access; higher obesity rates) exist across rural America, especially in the southeastern United States. These disparities coincide with negative socioeconomic factors such as poverty and low household income. Georgia’s 2020 preterm birth rate was seventh highest among the 50 U.S. states, its rate of low birth weight (LBW) babies was fourth among states. Methods: This study used a novel, combined spatiotemporal analysis to assess IMR and health trends in Georgia counties ( n = 159). We spatially regressed IMR on 14 biopsychosocial health variables and assessed IMR 2012–2022 longitudinal trends, rural versus urban or by Health Professional Shortage Area (HPSA) status, using a two-level hierarchical linear model. Results: Analyses demonstrated significant associations between IMR and rural counties as well as counties that have high African American populations, high unemployment, and high uninsurance rates. Principal Care Provider Rates showed a negative spatial regression relationship. There was a −0.056 IMR slope for urban counties from 2015 to 2022, whereas the rural county IMR slope was 0.135. Conclusions: Findings concur with previous research suggesting the need for coordinated county-specific socioeconomic development and corresponding increased health programs. Combined geospatial and multilevel models represent a novel approach to inform public health epidemiology.

Via allostasis, various physiological systems work together to protect the body amid various stressors. However, the wear and tear of allostatic load (AL) can ultimately predispose an organism to disease. The role of allostatic load in cardiovascular disease has been well-established, but studies have been inconclusive as to the relationship between allostatic load and sleep quality. This study explored the interplay between allostatic load and sleep disturbances. Using the National Health and Nutrition Examination Survey (NHANES) 2017-2020 Pre-Pandemic data, statistical analyses were conducted to assess associations between AL and sleep disturbances, including differences across sociodemographic and lifestyle factors. Increased AL was associated with increased prevalence of sleep disturbances such as sleep apnea symptoms. Correlations were found between increased AL and certain sociodemographic and lifestyle factors as well. Finally, increased pulse pressure was found to be associated with higher AL and older age. Results supported the idea that sleep quality and duration could be linked to AL physiological regulation and cardiovascular health. It also reinforced the idea that pulse pressure could be an indicator of cardiovascular risk, particularly for older adults. Therefore, sleep disturbances may represent a measurable indicator of AL and associated cardiovascular risk.

A growing number of cancers have been linked to specific oncogenic viruses and physiological stress. Recently, two separate studies linked mobility limitations to allostatic load and to four major cancer types. The objective of this study was to determine if cancer occurrence regresses on three latent domains of Allostatic Load, Level of Physical Functioning (i.e., Mobility Disability), and Viral Exposure. We compared several structural equation models using adult participant (n = 17,969) data from three National Health and Nutrition Examination Survey (NHANES) periods. The primary two-level model with three exogenous latent factors and a single Cancer endogenous latent factor demonstrated strong fit (GFI =0.948, RMSEA =0.024), and the model had a non-significant Chi-Square indicative of a strong model.