An examination of contributors to health in the MS River Delta Region

The Mississippi River Delta Region is among the most distressed areas of the United States. We used county-level data from the 2014 County Health Rankings for a variety of health factors to identify the key contributors to health outcomes and better understand the health disparity between Delta and non-Delta counties in the Mississippi River Delta Region. Data for the current study were sampled for the eight states (Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee) that encompass the Delta Region. The 252 Delta counties and county equivalents were identified using the Delta Regional Authority definition, leaving 468 non-Delta counties. Health outcomes consisted of one measure of mortality (years of potential life lost before the age 75) and two measures of morbidity (self-reported health and low birth weight). Health factors (34 measures) consisted of the following categories: Health Behaviors; Clinical Care; Social and Economic Factors; Physical Environment; and Demographic Variables. The contributions of health factors to health outcomes were explored using path analysis. For descriptive purposes, mean and standard deviation of raw values for each measure were calculated for Delta and non-Delta counties, as well as for the whole US, and differences between groups were examined using two-way ANOVA with Tukey post-hoc testing. Results of the analysis comparing the MS River Delta counties, non-Delta counties, and the national average on each of the health factors and health outcomes showed statistically significant differences among the groups for all but three measures. On average, values in the Delta were 16% worse than the non-Delta and 22% worse than the national average. In regards to the primary analysis, overall model fit was moderate for both the Delta and non-Delta samples. Our main finding was that there were not drastic differences in the primary contributors to health outcomes between the Delta and non-Delta counties, especially for the measures of morbidity. The most variation was seen in the predictors of mortality, but the primary contributor (i.e. income) was shared between the two. Overall it would appear that the health status of Delta counties is worse than non-Delta counties because the factors that matter towards the health of the entire Delta Region are worse in the Delta counties, not because there is an entirely different set of predictors of health there.