Year of Publication

2022

College

Public Health

Date Available

4-25-2022

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Keith Knapp

Committee Member

Rachel Hogg-Graham

Committee Member

Dana Quesinberry

Abstract

Abstract

Introduction: The United States is an increasingly aging nation, and aging increases the risk of cognitive decline. Information on the relationship between cognitive decline and geographic residence in the U.S. is limited. Available evidence suggests that rural residents tend to suffer persistent disadvantages in cognitive functioning when compared to sociodemographically similar urban peers. This analysis focused on women over 65 years of age living in the southeastern U.S. The primary objective of this analysis was to determine if there was a significant association between geographic residence and cognitive decline. A secondary objective was to explore variables of interest that may contribute to the relationship between geographic residence and cognitive decline.

Methods: Data from the 2019 BRFSS survey were used for this research. To determine if there was a significant relationship between cognitive decline and geographic residence, the primary analysis was a Chi-square test between the geographic residence variable and the cognitive decline variable. Chi-square tests were also performed between cognitive decline/geographic residence and 5 variables of interest: education level, income level, social support, exercise, and healthcare access. An ANOVA was performed between education level/geographic residence and income level/geographic residence, to determine if the means of these variables differed between urban and rural areas. A subgroup analysis was performed including only women who reported experiencing cognitive decline.

Results: A significant association was not observed between cognitive decline and geographic residence (p=0.75). Education, income, and exercise were shown to have significant associations with geographic residence. Significant associations were also observed between cognitive decline and education, income, exercise, and social support. Mean education level and mean income level were shown to significantly differ between urban and rural areas.

Conclusions: Despite the null results of the primary research question, previous research indicating rural cognitive health deficits and known rural health disadvantages make this an area worthy of further study. Understanding the social determinants of health, and particularly of cognitive health, and how these factors affect urban and rural populations differently, is an important step in improving health outcomes and promoting healthier aging.

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