 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Ruth L. Eudy, MSW, PhD, Graduate Program in Health Services Administration, University of Arkansas at Little Rock, 205 Ross Hall, 2801 S. University Avenue, Little Rock, AR 72204 and John B. Wayne, PhD, Health Services Administration, University of Arkansas at Little Rock, 2801 South University Avenue, 202 Ross Hall, Little Rock, AR 72204, (501)569-3385, jbwayne@ualr.edu.
Epidemiologists and medical geographers have long recognized the concept of “place” as one of the social determinants of health. Historically underdeveloped rural regions of this country, such as the Mississippi Delta, have experienced significantly higher incidence and prevalence of many kinds of morbidity and mortality and increased levels of socioeconomic risk factors such as poverty and unemployment. Although these indicators have shown improvement over the last decade, the gap between the Delta and the rest of the country remains. The study reported here illustrates a statistical method that has been used to model the impact of concentrated poverty on health outcomes in urban areas but that has application in rural areas as well. Using county-level data measured at three points in time in the states comprising the Delta region, it demonstrates a statistically significant threshold effect of region on the relationship between poverty and infant mortality in 1980 that had diminished by 1990 and no longer existed in 2000. Policy makers and planners have used differing geographical definitions of the Mississippi Delta. In this study, distinctions were made between the central Delta counties, the fringe Delta counties that were added to later definitions and the non-Delta counties within the states comprising the region. The primary research questions were whether the relationship between poverty and infant mortality was moderated by region, whether the magnitude of this relationship was greater in the central Delta, and whether the magnitude of the relationship remained stable over time. Statistical analysis included hierarchical linear regression models using Johnson-Neyman tests for significance of interaction effects. The slopes of infant mortality regressed on poverty were significantly different for all three regions in 1980, with R2s of 0.52 for the central Delta, 0.14 for the fringe Delta, and 0.04 for non -Delta counties. By 1990, the slopes of the central and fringe Delta remained significantly different from that of the non Delta counties. However, the R2s had decreased to 0.18 for the central Delta and 0.06 for the fringe Delta. By 2000, there was no longer a significant relationship between poverty and infant mortality within the central Delta region and R2 values for the other two regions were negligible. The presentation concludes with a discussion of possible explanations for these changes, particularly the impact of changes in healthcare delivery patterns and technological advances within the last two decades. Implications for future health policy and planning will be discussed.
Learning Objectives:
Keywords: Indicators, Rural Health Care Delivery System
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.