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Interdisciplinary Cardiovascular Health Research: Quantitative Methods Interdisciplinary Cardiovascular Health Research: Quantitative Methods, Heliogeophysical Influence, Demographics, and Spatial Trends by Joseph M. Caswell A thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy (PhD) in Human Studies The Faculty of Graduate Studies Laurentian University Sudbury, Ontario, Canada © Joseph M. Caswell, 2016 THESIS DEFENCE COMMITTEE/COMITÉ DE SOUTENANCE DE THÈSE Laurentian Université/Université Laurentienne Faculty of Graduate Studies/Faculté des études supérieures Title of Thesis Titre de la thèse Interdisciplinary Cardiovascular Health Research: Quantitative Methods, Heliogeophysical Influence, Demographics, and Spatial Trends Name of Candidate Nom du candidat Caswell, Joseph Degree Diplôme Doctor of Philosophy Department/Program Date of Defence Département/Programme Human Studies Date de la soutenance January 13, 2017 APPROVED/APPROUVÉ Thesis Examiners/Examinateurs de thèse: Dr. Michael Persinger (Supervisor/Directeur(trice) de thèse) Dr. Cynthia Whissell (Committee member/Membre du comité) Dr. John Lewko (Committee member/Membre du comité) Approved for the Faculty of Graduate Studies Approuvé pour la Faculté des études supérieures Dr. David Lesbarrères Monsieur David Lesbarrères Dr. Borislav Dimitrov Dean, Faculty of Graduate Studies (External Examiner/Examinateur externe) Doyen, Faculté des études supérieures Dr. Frank Mallory (Internal Examiner/Examinateur interne) ACCESSIBILITY CLAUSE AND PERMISSION TO USE I, Joseph Caswell, hereby grant to Laurentian University and/or its agents the non-exclusive license to archive and make accessible my thesis, dissertation, or project report in whole or in part in all forms of media, now or for the duration of my copyright ownership. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also reserve the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. I further agree that permission for copying of this thesis in any manner, in whole or in part, for scholarly purposes may be granted by the professor or professors who supervised my thesis work or, in their absence, by the Head of the Department in which my thesis work was done. It is understood that any copying or publication or use of this thesis or parts thereof for financial gain shall not be allowed without my written permission. It is also understood that this copy is being made available in this form by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner. ii Abstract The study of cardiovascular health involves myriad scientific disciplines associated with diverse factors that contribute to health which further necessitates interdisciplinary endeavors. The current series of studies concern cardiovascular health from multiple interdisciplinary perspectives including biomedical signal processing, heliobiology, and public health, with a particular focus on quantitative methods throughout. The first study examined heart rate variability (HRV) derived from healthy and arrhythmia human electrocardiograph records. Data processed using wavelet entropy was quantitatively novel compared to traditional indices of HRV and also demonstrated significant accuracy for prediction and classification of arrhythmia. Next, heliobiological perspectives of cardiovascular physiology were examined beginning with experimental verification of previous correlational results. Artificially simulated geomagnetic impulses were associated with significant increases in participant HRV, particularly for frequency-based components. An additional pilot case study demonstrated similar effects for natural geomagnetic storms, while a nonlinear relationship was observed overall for HRV and geomagnetic activity. National data regarding mortalities due to hypertensive diseases in Canada from 1979 to 2009 were aggregated and investigated for periodic components and relationships with space weather parameters. Time-lagged linear correlations were observed along with conspicuously overlapping temporal trends, for which geomagnetic activity and solar wind pressures were identified as central sources of variance. Finally, three ecological cross-sectional studies investigated sub-provincial cardiovascular concerns across Canada at the health region level with emphasis on demography and spatial statistics. Hospitalizations due to myocardial infarction demonstrated significant relationships with socioeconomic and behavioral factors as well as significant geospatial clustering of high rates in Northern Ontario and Quebec. Aggregate rates of self-reported hypertension were similarly related to income and demographics with spatial results demonstrating high rates clustered in the North Atlantic, particularly Newfoundland. Furthermore, analyses for hypertension specifically among older adult Canadians (≥ 65 years of age) suggested that education was the strongest contributor at the health region level and there were no significant spatial relationships, in contrast to age-standardized rates. Various implications and other relevant associations are discussed throughout. iii Keywords Cardiovascular health, multivariate statistics, signal processing, spatial statistics, public health, demographics, heart rate variability, generalized linear models, time series analysis, heliobiology, space weather, nonlinear models, solar activity, geomagnetic activity, arrhythmia, hypertension, myocardial infarction, socioeconomic determinants of health iv Co-Authorship Statement Chapter 2: Sample A (healthy sample) data were collected during study from Chapter 3. Chapter 3: Manraj Singh and Suzanne Fleming assisted with laboratory data collection; Dr. Michael A. Persinger assisted with magnetic field measurement, contributed introduction and discussion sections on electromagnetic field theory, and designed magnetic field equipment with Stan Koren. Chapter 5: Trevor N. Carniello provided non-statistical calculations of physical dimensions in results section and assisted with writing discussion; Dr. Nirosha J. Murugan assisted with writing introduction and discussion. v Original Chapter Citations Chapter 2: In submission Chapter 3: Caswell, J. M., Singh, M., & Persinger, M. A. (2016). Life Sciences in Space Research, 10: 47- 52. DOI: 10.1016/j.lssr.2016.08.001 Chapter 5: Caswell, J. M., Carniello, T. N., & Murugan N. J. (2016). International Journal of Biometeorology, 60: 9-20. DOI: 10.1007/s00484-015-1000-3 Chapter 6: Caswell, J. M. (2016). Public Health, in press. DOI: 10.1016/j.puhe.2016.07.006 Chapter 7: Caswell, J. M. (2016). Journal of Public Health, in press. DOI: 10.1007/s10389-016-0761-4 vi Acknowledgments I would first like to thank Dr. Michael A. Persinger for his mentorship and support over many years, as well as his friendship, and for allowing me the freedom to pursue my own research interests during all stages of my studies. I would also like to extend gratitude to Dr. Cynthia Whissell, a kindred spirit in quantification who has helped as an academic guide and member of thesis committees over a number of years, always with a great deal of support and enthusiasm. Many thanks are owed to Dr. John Lewko for assistance and support in myriad forms, especially for providing important opportunities in earlier graduate studies, and for wading outside of more familiar territory as part of the current dissertation committee. Thanks are also extended to the Neuroscience Research Group (NRG) at Laurentian University for their friendship over many years. Special thanks are owed to Lucas W. E. Tessaro, Trevor N. Carniello, Nicolas Rouleau, and Dr. Nirosha J. Murugan of the NRG, as well as Suzanne Fleming and Manraj Singh for additional contributions and assistance, and to Prof. Stan Koren for engineering experimental equipment. The accelerated completion of this dissertation would not have been possible without the support of many scientific colleagues at home and abroad. This work is dedicated to the memory of Alexander Chizhevsky (1897-1964), John Snow (1813- 1858), Franz Halberg (1919-2013), Ronald Fisher (1890-1962), and Karl Pearson (1857-1936). vii Table of Contents Abstract .......................................................................................................................................... iii Co-Authorship Statement................................................................................................................ v Original Chapter Citations ............................................................................................................. vi Acknowledgments......................................................................................................................... vii Table of Contents ......................................................................................................................... viii List of Tables ............................................................................................................................... xiii List of Figures .............................................................................................................................. xvi Chapter 1 – Introduction ................................................................................................................. 1 1. General Introduction ...........................................................................................................
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