Infant Mortality and Life Expectancy in Appalachia Versus the Rest of the US

Appalachia—the region from Mississippi to New York—faces historic health, social, and economic disparities compared with the rest of the United States. Infant mortality and life expectancy rates in this region are expected to remain substantially worse until there are changes in the certain inequalities, including education, poverty, housing, and labor market opportunities, according to researchers.

A study published by Health Affairs compared infant mortality and life expectancy disparities in Appalachia to those in outside regions from 1990 to 2013. The Appalachia region, as defined by the 2008 Appalachian Regional Commission, covers 428 counties among 13 states. Researchers collected the infant mortality rates and life expectancy at birth 7 times during the period and collected the participants’ demographics, including poverty levels.

The researchers found that the population in Appalachia grew by 16% during the study period, while the rest of the United States grew by 25%. Furthermore, the socioeconomic status is also lower in Appalachia, with higher poverty, lower rates of physician availability with a greater need for healthcare services.

From 2009 to 2013, the infant mortality rate was 16% higher in Appalachia than the rest of the United States with an even greater disparity among black infants. High-poverty levels further affected this rate, as infant mortality rates in 2009 to 2013 were 39% greater than low-poverty areas.

The Appalachia region’s life expectancy from 1990 to 1992 was 75.2 years—0.6 years shorter than the rest of the United States; however, from 2009 to 2013, this deficit increased to 2.4 years. The association between poverty level and life expectancy was more apparent in Appalachia than the rest of the United States, as those in high-poverty areas had a life expectancy of 75.1 years, while those in low-poverty areas were likely to live to 79.9 years old.

“It should be noted that with social and economic inequality continuing to increase and rates of obesity and related chronic conditions rising, there is no guarantee that life expectancy and mortality rates will continue to improve in the United States and its regions, including Appalachia,” the researchers wrote.

The study suggested that in order to reduce the gap among certain US regions there needs to be policy changes at various government levels that promote increased access to high-quality affordable health care. Such policies and education measures could assist in decreasing the high mortality rates from cardiovascular diseases, lung cancer, chronic lower respiratory diseases or chronic obstructive pulmonary disease, diabetes, nephritis or kidney diseases, suicide, unintentional injuries, and drug overdoses.

“Disparities between Appalachia and the rest of the United States in infant mortality and life expectancy are expected to remain substantial for the foreseeable future, given that differences in mortality from several major causes of death are persisting or even increasing,” the study concluded. “Health policy interventions such as smoking reduction, anti-obesity measures, and improved access to healthcare have the potential to reduce health disparities between Appalachia and the rest of the country.”