Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Derek Chapman



Functional disability and stress-related conditions (SRC) mortality are major public health concerns in the U.S. The rate of adult functional disability and SRC mortality in the U.S. has seen successive increases over the past decade. Previous studies have suggested that community characteristics and a degree of urban or rural status may be associated with these outcomes.


The objectives of this dissertation were: 1) to evaluate whether urban/rural continuum data improves small area estimation models of functional disability prevalence within Virginia, and 2) to examine the extent to which county-level factors are associated with SRC mortality across the U.S.


Multilevel logistic regression and post-stratification were used to compute Virginia's functional disability prevalence. For the stress-related conditions (SRC) mortality outcome, Bayesian modeling was used to examine the association between community characteristics and SRC mortality.


The results indicated that the small area estimation model incorporating a continuous measure of rurality provided more reliable estimates of functional disability than its counterpart models that used discrete measures of rurality. The Bayesian spatial analysis results indicated that the degree of rurality, population with a disability, and population with low access to grocery stores were positively associated with SRC mortality risk.


Spatial disparities in functional disability and SRC mortality exist across the U.S. Social determinants of health at the county level are important factors in explaining high SRC mortality rates. A comprehensive strategy that includes both downstream interventions and upstream efforts is warranted to reduce these morbidity/mortality burdens effectively.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission


Available for download on Saturday, August 07, 2027