Appalachia’s gap with rest of U.S. in life expectancy is growing

Life expectancy in Appalachia, a region that stretches from Mississippi to New York, lags behind the rest of the U.S. - and the divide is widening, a new study suggests.

People live longer today than they did a generation ago, and infant deaths are rarer. But less-rapid declines in infant mortality in Appalachia, coupled with slower gains in life expectancy, have contributed to a deeper chasm between survival odds in the region and the rest of the country, researchers report in Health Affairs.

'The growing disparities in infant mortality and life expectancy are quite surprising,” said lead study author Gopal Singh, a researcher at the Health Resources and Services Administration in Rockville, Maryland.

'Smoking-related diseases accounted for more than half of the life expectancy gap between Appalachia and the rest of the country,” Singh said by email.

Higher mortality in Appalachia from heart disease, lung cancer, respiratory disorders, diabetes, kidney problems, suicide, accidental injuries, and drug overdoses all contribute to the widening survival disparities between the region and the rest of the country, the researchers note.

Children born in Appalachia from 2009 to 2013 have a life expectancy of 76.9 years, compared with 79.3 years for the rest of the U.S., the study found. For people born in Appalachia between 1990 and 1992, the gap is narrower; for those young adults, life expectancy is seventh months shorter than it is for the U.S. as a whole.

In the early 1990s, infant mortality rates in Appalachia were similar to the those in rest of the U.S., at about 9.3 deaths for every 1,000 live births. Deaths declined in the region and the nation as a whole during the next two decades, but infant mortality rates also became 16 percent higher in Appalachia than the rest of the country.

Within Appalachia, poverty had a big effect on survival odds, the study found.

People born in the poorest areas in Appalachia by the end of the study period had a life expectancy of 75.1 years, compared with 79.9 years for people born in low-poverty areas.

Black men born in the poorest parts of Appalachia had a life expectancy of just 70.4 years, lagging behind white women in low-poverty areas in the rest of the U.S. by more than a decade.

'The relationship between poverty and life expectancy is stronger in Appalachia than in the rest of the United States,” Singh said.

'Poverty can lead to mental stress,” Singh added. 'It also forces people to live in social environments that could put them at risk for poor health and social outcomes, including lower socioeconomic attainment and mobility, lack of jobs and economic opportunities; higher risks of smoking, obesity, physical inactivity, and poor diet; and lower access to quality health care, which are all associated with higher mortality and lower life expectancy.”

It's possible that poverty may be a stronger predictor of poor health in Appalachia than in the rest of the country because of the high concentration of poor people in the area, said Jennifer Karas Montez, a sociology researcher at Syracuse University in New York who wasn't involved in the study.

'It is one thing to be poor but live in a mixed-income area, in a community that is socially integrated, and with access to amenities that promote a healthy lifestyle,” Montez said by email. 'It is entirely different being poor in an area where destitution is all around - like so much of Appalachia.”