A Tale of two Tails: How access to needed care differs across the Appalachian border in two states

Background:  Disparities in access to adequate health care services has been linked to geographic factors for adults and children.  One area of specific concern is the Appalachian region of the United States where healthcare access is a known but understudied problem. Appalachian communities overall have been shown to have less access to care, lower levels of insurance, and higher costs of care than other US states or the US average. However, Appalachia is vast and specific state-based analyses are lacking.

Study Objectives: To understand whether children in a primarily Appalachian state differ in care access than those in a bordering non-Appalachian state, specifically Virginia and West Virginia. West Virginia is almost fully immersed in Appalachia and ranks 49^th in percapita income while Virginia ranks 5^th.

Methods & Results:  Using data from the 2011 National Survey of Children’s Health, we examined access to and receipt of needed care in Virginia and West Virginia.  Access to care was defined using sixteen questions related to needed, used and foregone care.  Bivariate and logistic regressions examined place on needed care controlling for a number of socioeconomic and socio-demographic variables. Initial findings show that those in West Virginia (Appalachia) received significantly less needed care than those in Virginia.

Conclusions:  Appalachian children could realize significant health impacts health even when controlling for other factors of income, race, age, and insurance status than children in neighboring non-Appalachian communities.  Specific policies should consider the geographic factors that contribute to these disparities.