Study finds Appalachian health is falling farther behind the rest of the nation, and Kentucky's health falls behind Appalachia's

By Melissa Patrick
Kentucky Health News

When it comes to health, Appalachia is falling farther behind the rest of the nation, and the part of the region dominated by Kentucky has the poorest health statistics.

So says a comprehensive report from the Appalachian Regional Commission, the Robert Wood Johnson Foundation and a Kentucky foundation, looking at a range of health measures in Appalachia.

"Appalachian Kentucky is behind not only the rest of the nation, it's behind Appalachia," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the study.

The report, “Health Disparities in Appalachia,” not only paints a grim picture of the region's health status, but also shows that even in the areas of improvement, Appalachia hasn't kept up with the rest of the nation, and continues to fall behind.

The researchers found that over two decades, Appalachia and the rest of the U.S. saw improvements in seven of the eight health measures examined: deaths from heart disease, cancer and stroke; infant mortality, the supply of primary care doctors, education levels, years of potential life lost. Poverty was the only measure that increased.

But when compared to the rest of the nation, Appalachia's improvements lagged behind in all but one of those measures, the supply of primary-care physicians.

The greatest gap was in life expectancy, the most fundamental measure of a place's health. The report measured it in "years of potential life lost." Over the last two decades, the U.S. saw a 24 percent decrease in premature deaths, while the Appalachian region only saw an 8 percent decrease. The Appalachian rate was one-fourth higher than the nation as a whole.

A news release about the study noted that the nation's improvements have often outpaced those in Appalachia.

For example, in the 1990s, the cancer death rate in Appalachia was only 1 percent higher than the rest of the nation, but more recently it is 10 percent higher. The infant-mortality rates were 4 percent higher in Appalachia in the '90s, but are now 16 percent higher.

The report also analyzed 41 health indicators and how the 420 Appalachian counties compared to the rest of the nation in those measures, as well as how parts of the region compared to one another. The data is also broken down by state.

It found that Appalachia has a higher death rate than the rest of the nation - by at least 10 percent -- in seven of Americas leading causes of death, including heart disease, cancer, chronic obstructive pulmonary disease, injury, stroke, diabetes and suicide.

And Kentucky's rates for these measures were even higher, when compared to both the national and Appalachian rates: heart disease deaths were 45 percent higher in Kentucky, compared to 17 percent higher in the region; cancer deaths were 35 percent higher, compared to 10 percent higher in the region; and diabetes deaths were 32 percent higher, compared to 11 percent higher in the region.

One of the greatest differences between Appalachia and the rest of the nation is in the number of deaths caused by an injury, which are 33 percent higher in the region. Injury deaths include things like motor vehicle accidents, falls and drug overdoses.

Foundation for a Healthy Kentucky chart shows how much more common, in percentages,
health problems are in Appalachia and Appalachian Kentucky, compared to national rates.

Appalachian sub-regions are outlined in red.

These deaths were more than twice the national rate in Kentucky, at 80.1 injury deaths per 100,000 people compared to 39.5 per 100,000 nationally.

The overdose, or poisoning, deaths were a whopping 141 percent higher in Kentucky, 146 percent higher in Central Appalachia, which is dominated by Kentucky, and 79 percent higher in North Central Appalachia than in the nation as a whole.

The premature death rate in Central Appalachia was much higher than the other sub-regions, 68 percent higher than the national average. Kentucky's rate was 63 percent higher.

Click on any map to view a larger version of it.

Appalachian suicide rates were also higher than the national rates by 17 percent, and were 31 percent higher in Central Appalachia.

“In measure after measure, the Central Appalachian region—including Eastern Kentucky—faces greater health challenges, and gaps are widening at a faster rate, than in the rest of Appalachia and the nation,” Chandler said in the news release. “Appalachia’s economic livelihood is absolutely dependent on improving these health measures."

The report also notes that the Appalachian region’s rural counties have higher death rates than the region’s large metro counties for each of the mortality measures, "signifying a stark rural-urban divide in the region": in rural counties, heart disease is 27 percent higher; cancer is 15 percent higher; COPD is 55 percent higher; injury is 47 percent higher; stroke is 8 percent higher; and diabetes is 36 percent higher. Premature deaths are 40 percent higher in rural Appalachian.

Foundation graphic shows how much more common, in percentages, social
determinants of health problems are in Appalachia compared to national rates.

It comes as no surprise that many of the risk factors for poor health are also more prevalent in the Appalachian region, including fewer health care providers, higher rates of diabetes and obesity, higher rates of physical inactivity and higher smoking rates.The region also has lower incomes, higher poverty rates, more people on disability and lower shares of residents with some college education -- and all of these risk factors are higher in Kentucky.

Chandler said that with smoking rates in Kentucky 59 percent higher than the national average and 23 percent higher than the Appalachian region, reducing this rate would be a sure way to improve the health of Kentuckians.

"The single most effective policy changes that this state, Kentucky, can make to improve health are changes that will reduce our smoking rate and exposure to second-hand smoke," he said. "That ought to be low hanging fruit."

Chandler said the foundation supports smoke-free laws to decrease exposure to second-hand smoke and an increase in the tobacco tax by at least $1/pack toward this goal.

One bright spot is the Appalachian region's high rate of social associations, at 33 percent. This is a measure of the number of social organizations available and may very well end up being part of the solution to improve the region's health."Greater levels of social relationships and interaction positively affect a number of outcomes, included those associated with both mental and physical health,” says the report.

This measure could also contribute to Appalachian Kentucky's poor health as the state's rate for this measure is lower than the regions, 8.6 social organizations per 10,000 people compared to 12.5 per 10,000.

The region also has lower incidence of chlamydia, lower prevalence of HIV, higher student-teacher ratios, and better diabetes monitoring among Medicare patients than the nation as a whole.

“This report begins to identify key health challenges confronting Appalachia,” ARC Federal Co-Chair Earl F. Gohl said in the release. “Now we need to understand the implications these findings have for Appalachia’s economy so we can continue working towards a brighter future for the Region.”

This report is part of multi-part research project titled “Creating a Culture of Health in Appalachia: Disparities and Bright Spots.” The next report will explore “bright spots,” Appalachian communities that have better-than-expected health outcomes given their resources, with the goal of identifying activities, programs or policies that other struggling communities could replicate.