Corresponding Author

W. Jay Christian


Author Affiliations

W. Jay Christian, PhD, MPH

Dept. of Epidemiology, University of Kentucky, Lexington, KY

ORCID iD: 0000-0001-6904-3971


Background: Research has demonstrated that common chronic conditions, especially those related to cardiovascular health, are important risk factors for severe COVID-19 symptoms or hospitalization. Population prevalence rates of such conditions have not previously been examined in relation to COVID-19 case fatality rates in the Central Appalachian region.

Purpose: This study examined prevalence rates of selected chronic conditions and COVID-19 case fatality rates to determine whether the relationship between them is consistent across Appalachian and non-Appalachian regions of Kentucky.

Methods: Data from Kentucky’s Behavioral Risk Factor Survey (KyBRFS) were used to calculate prevalence rates of asthma, diabetes, influenza vaccination, hypertension, obesity, having a personal doctor, physical inactivity, and cigarette smoking. Publicly available COVID-19 case and death counts by county were used to calculate incidence and case fatality rates. Units of analysis were 41 single- and multi-county areas developed to visualize KyBRFS prevalence rates. Analysis included t-tests to compare Appalachian and non-Appalachian regions, and correlations characterizing associations between COVID-19 case fatality and rates of chronic conditions and behaviors.

Results: Incidence and case fatality rates for COVID-19 were slightly lower in the Appalachian region, but not significantly. Significant correlations between COVID-19 case fatality and the prevalence of chronic conditions and behaviors were more common in the non-Appalachian region.

Implications: Case fatality rates in Appalachia appear lower than expected, given the high prevalence of important chronic conditions and behaviors known to be associated with poor COVID-19 outcomes. This phenomenon merits further research and should be considered by public health researchers when examining COVID-19 outcomes in Kentucky and neighboring states.



Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Christian WJ. Exploring COVID-19 Case Fatality in Relation to the Prevalence of Chronic Conditions and Health Behaviors in Appalachian Kentucky. J Appalach Health 2021;3(2):43–55. DOI: https://doi.org/10.13023/jah.0302.05