By Taylor Knopf

While life expectancy and infant mortality rates continue to improve across the United States, the Appalachian region struggles to keep up.

Infant mortality is 16 percent higher in Appalachia than other areas of America, according to a study published in Health Affairs this month called “Widening disparities in infant mortality and life expectancy between Appalachia and the rest of the United States, 1990–2013.”

The authors used information from 428 counties stretching over 13 states, from Mississippi to New York, this includes 29 western North Carolina counties and compared outcomes against the rest of the U.S.

Poverty Rates in Appalachia, 2010-2014 (US Average = 15.6%;
Appalachian Average = 17.2%) Data source: US Census Bureau. American Community Survey, 2010‐2014. Map created by the Appalachian Regional Commission. March 2016

In 1990, life expectancy for both men and women of all races living in Appalachia was 75.2 years, only about half a year shorter than the average across the U.S. at the time. Between 2009 and 2013, a gap between Appalachia and the rest of the U.S. developed, which now stands at 2.4 years.

The average American in the greater United States is living about 79.3 years, while the average person in Appalachia is expected to live only 76.9 years.

Study co-author Rebecca Slifkin, now a clinical associate professor in the Department of Health Policy and Management at UNC Chapel Hill’s public health school, said this figure is “startling.”

“It’s a really big gap. Think about as a society what we are willing to pay to keep a cancer patient alive for an extra two and a half years,” she said. “If we took the same amount of money and invested it in public health, imagine what would happen.”

Slifkin was asked to co-author this study when she still worked for the U.S. Department of Health and Human Services. She and her co-authors, Gopal Singh and Michael Kogan who both still work at HHS, were pleased with the widespread media coverage that study has received.


“I think the important story is we have a part of our country that’s being left behind,” Slifkin said. “Health outcomes depend so much on where you live. As someone involved in health policy, and I think I can speak for my co-authors as well, that’s just not OK. We have to figure out what we can do differently.”

The study noted that the average socioeconomic status is lower in Appalachia than the rest of the United States, with higher poverty and unemployment rates and lower education levels.

Slifkin said that while Medicaid expansion would be helpful for Appalachia, there are huge issues that go beyond simply providing better access to care. Appalachian states such as West Virginia did expand Medicaid and are still seeing the same health disparities. She said there are underlying economic issues that need to be addressed also.

“Appalachia also has a lower rate of physician availability but higher indicators of need for health care services, such as prevalence of adult smoking, obesity, physical inactivity, disability, and diabetes,” the study reads. “Rates of preterm birth, low birthweight, maternal diabetes, and maternal hypertension are significantly higher in Appalachia.”

The study also highlighted how opioid abuse and overdoses have contributed to the life expectancy gap in Appalachia compared to the rest of the U.S.

“Between 1999 and 2013 in the United States, the age-adjusted mortality rate from all drug overdose deaths more than doubled. The rate from drug overdose deaths involving opioid analgesics more than tripled. And the rate from those deaths involving heroin nearly tripled,” the study reads.

The higher numbers of drug overdose deaths that increased at faster rates in Appalachia accounted for 6.3 percent of the life expectancy gap in Appalachia between 1999 and 2013, the authors of the study say.

Slifkin noted that the data for their study ended four years ago, and they were only beginning to capture what has grown into the opioid epidemic everyone is talking about now.

“This seems to suggest that drug overdose is becoming an increasingly important determinant of the widening life-expectancy gap between Appalachia and the rest of the country,” the study reads.

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...