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Age differences in Allostatic Load among adults in the United States by rural-urban residence

Alexis R. Santos-Lozada, Jeffrey T. Howard, Shannon Monnat, Martin J. Sliwinski, Leif Jensen

SSM - Population Health, June 2023

Shannon Monnat

Shannon Monnat

Rural populations in the United States (US) exhibit worse health outcomes than urban populations (Rhubart & Monnat, 2022; Sparks, 2012). Rural disparities have been observed in self-rated health status, chronic conditions, disability, physical activity, health behaviors, access to care, and mortality (Jensen et al., 2020).

Chronic stress and physiological dysregulation contribute to chronic conditions and premature mortality (Borrell et al., 2010; Mattei et al., 2010), particularly from the causes of death that have contributed to the rise in the rural mortality disadvantage in recent decades (cardiovascular and metabolic diseases, cancers) (Elo et al., 2019; Monnat, 2020; Abrams et al., 2021).

Despite these well-documented rural disadvantages in population health, little is known about rural-urban differences in chronic stress and physiological dysregulation. A rural disadvantage in this regard could be implicated in the persistent rural disparities found in health and mortality (Bolin et al., 2015; Probst et al., 2020).

The allostatic load index (AL) is a measure of cumulative “wear and tear” of biological systems due to exposure to chronic stress (Geronimus et al., 2006) and provides a way to assess rural-urban differences in chronic stress and physiological dysregulation.

Previously, AL has been leveraged to explore “weathering” by assessing patterns by age, and to compare population subgroups by exploring differences by sex and race (Geronimus et al., 2006; Langellier et al., 2021). These studies consistently find that older adults have higher AL than their younger peers (Crimmins et al., 2003). .

Our aim is to document age-gradient differences in AL between rural and urban populations. Studying rural-urban disparities in AL is important for understanding rural disadvantages in population health more generally.

We hypothesize that a rural disadvantage in AL will be observed across all age groups. We assess our hypothesis through analysis of a publicly available population-based U.S. sample of people aged 18 years and older.