Overall white infant mortality rates in Appalachian counties were significantly higher than in non-Appalachian counties during a 20-year period, according to study results.
“It is still true that babies born from poor and rural families are at a higher risk of early death,” study researcher Nengliang Yao, MS, told Healio.com
Yao, along with fellow Penn State researchers Stephen Matthews, PhD and Marianne Hillemeier, PhD, analyzed data from 1,100 counties — 420 of which are designated as Appalachian by the Appalachian Regional Commission — in 13 states. Their study included data from 1976 to 1980 and from 1996 to 2000, taken from the Area Resource File, a national health resource information database that provides county- and city-level infant mortality rates, poverty rates, rural-urban continuum codes and the number of physicians. The researchers used multivariate regression analyses to determine the association between Appalachian counties and infant mortality during each time period.
According to the researchers, the study focused on white infant mortality because of the small number of infant deaths among other races in numerous counties across the study region. “The Appalachian population was overwhelmingly white non-Hispanic during the late 1970s,” they wrote, “and this population group remained the majority through the end of the study period.”
The 2000 US Census Bureau shows that 89% of the Appalachian population was white.
Although infant mortality rates decreased substantially across all subregions, analyses showed “persistent disparities in mortality rates in some regions, especially central Appalachia” (non-Appalachia=12.08% in 1976 to 1980 and 5.97% in 1996 to 2000 vs. Appalachia=13.13% in 1976 to 1980 and 6.73% in 1996 to 2000), according to the researchers.
During both time periods, Appalachian counties had significantly fewer physicians than surrounding regions. Between 1976 and 1980, central Appalachia had approximately one physician per 2,000 residents, compared with the non-Appalachian region, which had approximately one physician for every 500 people. These numbers improved during the next decade, according to the researchers, but central Appalachia still trailed non-Appalachian counties, with one physician per 1,000 residents, compared with one physician for every 350 residents.
The poverty rate in all subregions improved as well, but with the same progressive disparities (non-Appalachia=8.49% in 1979 and 7.81% in 1999 vs. Appalachia=12.22% in 1979 and 11.83% in 1999).
The researchers said previous studies have identified higher rates of cancer, heart disease and premature mortality in Appalachia, and populations in the region “have also been disproportionately exposed to a range of other adverse health risks including environmental contamination, food insecurity, substandard housing conditions and tobacco use and second-hand smoke.”
Disclosure: The researchers report no relevant financial disclosures.