Online Program

Health-related quality of life among residents of 13 states with Appalachian counties: Findings from the 2008-2010 behavioral risk factor surveillance system

Monday, November 4, 2013

Kai Bullard, PhD, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
Patricia Thompson-Reid, MAT, MPH, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
Lawrence Barker, PhD, Office of the Director, CDC, NCCDPHP, Division of Diabetes Translation, Atlanta, GA
Richard Crespo, PhD, Center for Rural Health, Marshall University, Huntington, WV
Eric Stockton, BA, Appalachian Regional Commission, Washington, DC
Background: The Appalachian Region comprises all of West Virginia and parts of Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia. In 2008-2010, about a quarter of adults in Appalachian states resided in Appalachian counties. The Appalachian Regional Commission (ARC) designated 98 counties as economically "distressed" and 99 counties as "at-risk" for severe economic decline. Methods: We used data from 309,376 adults aged ≥18 years in the 2008-2010 Behavioral Risk Factor Surveillance System to compare three health-related quality-of-life measures (self-rated fair/poor health, physically unhealthy days, and mentally unhealthy days), stratified by county of residence. Appalachian counties were designated according to relative economic strength as either DA: distressed or at-risk, or TCA: transitional, competitive, or attainment. Other counties in Appalachian states were classified as "non-Appalachian." Adjusted means and percentages were calculated using regression models, controlling for age, sex, race/ethnicity, education, BMI, smoking status, physical inactivity, and diabetes status. Results: DA county residents were more likely to report fair/poor health (21.6% [20.8-22.5] vs. 16.4% [16.0-16.8]) and 15.3% [15.0-15.5], respectively) than residents of TCA or non-Appalachian counties, and reported more mean mentally unhealthy days (4.20 [3.98-4.42] vs. 3.69 [3.59-3.79] and 3.53 [3.47-3.59]) and physically unhealthy days (4.79 [4.59-5.00] vs. 3.83 [3.74-3.92] and 3.61 [3.56-3.67]) than residents of TCA or non-Appalachian counties. Conclusion: Residents of DA Appalachian counties reported worse health-related quality of life than their counterparts in TCA or non-Appalachian counties, suggesting the need to prioritize targeted interventions and social investment in the Appalachian region.

Learning Areas:

Assessment of individual and community needs for health education

Learning Objectives:
Evaluate economic and health disparities, both between Appalachia and the rest of the country and within Appalachia. Describe how economic disparity within the Appalachian region is associated with the health related quality of life measures, 2008-2010. Discuss the public health relevance of using health related quality of life measures to assess attitudes concerning physical, mental, and social wellbeing.

Keyword(s): Quality of Life, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I manage all health programs of the Appalachian Regional Commission including partnership activities with the authors, and I am therefore familiar with the economic conditions, health disparities, and program opportunities in the counties assessed in this study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.