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. 2019 Jul 6;1(2):7-18.
doi: 10.13023/jah.0102.02. eCollection 2019.

Investigating the impact of the diseases of despair in Appalachia

Michael Meit  1 , Megan Heffernan  2 , Erin Tanenbaum  3
Affiliations

Investigating the impact of the diseases of despair in Appalachia

Michael Meit et al. J Appalach Health. .

Abstract

Introduction: Appalachia is one of the regions most significantly impacted by the opioid crisis. This study investigated mortality due to diseases of despair within the Appalachian Region, with an additional focus on deaths attributable to opioid overdose.

Methods: Diseases of despair include: alcohol, prescription drug and illegal drug overdose, suicide, and alcoholic liver disease/cirrhosis of the liver. Mortality data from the National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS) Multiple Cause of Death database were analyzed for this study, focusing on individuals aged 15-64.

Results: Over the past two decades, the mortality rate due to diseases of despair has been increasing across the United States, but the gap has widened between the Appalachian Region and the rest of the nation. In 2017, the combined diseases of despair mortality rate was 45% higher in the Appalachian Region than the non-Appalachian United States. When looking at just overdose mortality, this disparity grows to 65% higher in the Appalachian Region. Within the Appalachian region disparities are most notable in the Central and North Central Appalachian subregions, among males, and among individuals age 45 to 54.

Discussion: These findings document the scale and scope of the problem in Appalachia and highlight the need for additional research and discussion in terms of effective interventions, policies, and strategies to address these diseases of despair. Over the past two decades, mortality from overdose, suicide, and alcoholic liver diseases/cirrhosis has increased across the United States, but the disparity between Appalachia and the non-Appalachian U.S. continues to grow.

Keywords: Appalachia; mortality; opioids; overdose.

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Figures

Figure 1
Figure 1
Map of the Appalachian Region
Figure 2
Figure 2
Annual mortality rates attributable to diseases of despair, ages 15–64, by region (1999–2017)*‡ ‡Rates are presented as deaths per 100,000 population. Rates are age adjusted. *In all years except 1999, the Appalachian rate is significantly different from the non-Appalachian U.S. rate, p ≤0.05 Source: Mortality Rates and Standard Errors provided by Centers for Disease Control and Prevention, National Center for Health Statistics. Accessed at http://wonder.cdc.gov/mcd-icd10.html
Figure 3
Figure 3
Diseases of despair mortality rates, ages 15–64, by disease and region (2017)*‡ ‡Rates are presented as deaths per 100,000 population. Rates are age adjusted. *For all diseases, the Appalachian rate is significantly different from the non-Appalachian U.S. rate, p ≤0.05 Source: Mortality Rates and Standard Errors provided by Centers for Disease Control and Prevention, National Center for Health Statistics. Accessed at http://wonder.cdc.gov/mcd-icd10.html
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References

    1. Appalachian Regional Commission. Subregions in Appalachia. 2009. https://www.arc.gov/research/MapsofAppalachia.asp?MAP_ID=31 .
    1. Pollard K, Jacobsen LA.The Appalachian region: a data overview from the 2013–2017 American community survey chartbook. 2019. May, https://www.arc.gov/assets/research_reports/DataOverviewfrom2013to2017AC... .
    1. Marshall JL, Thomas L, Lane NM, et al. Health disparities in Appalachia. Appalachian Regional Commission. 2017 Aug; https://www.arc.gov/assets/research_reports/Health_Disparities_in_Appala... .
    1. Appalachian Regional Commission. Data snapshot: poverty in Appalachia. 2019. https://www.arc.gov/noindex/research/ACS-infographics2013-2017/DataSnaps... .
    1. Appalachian Regional Commission. Data snapshot: employment in Appalachia. 2019. https://www.arc.gov/noindex/research/ACS-infographics2013-2017/DataSnaps... .

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