Corresponding Author

Beatrice Ugiliweneza, PhD, MSPH

Associate Professor,

Kentucky Spinal Cord Injury Research Center,

Department of Neurology, College of Medicine

University of Louisville

Louisville KY

E-mail: Beatrice.ugiliweneza@louisville.edu

Author Affiliations

1. Sonali S. Salunkhe, MD, PhD, MPH: Assistant Professor of Healthcare Administration, College of Business, Idaho State University (Pocatello ID); E-mail: sonalisalunkhe@isu.edu

2. Sahal Alzahrani, PhD, MSc: Lecturer (Public Health Department), College of Health Sciences, Saudi Electronic University (Jeddah, Saudi Arabia); E-mail: s.alzahrani@se.edu.sa

3. Beatrice Ugiliweneza, PhD, MSPH: Associate Professor, Kentucky Spinal Cord Injury Research Center, Department of Neurology, College of Medicine, University of Louisville (Louisville KY); E-mail: Beatrice.ugiliweneza@louisville.edu

Author Area of Expertise

No areas of expertise given, but see above for affiliations


Introduction: In the opioid epidemic, the U.S. faces a significant public health crisis, with some areas of the country, such as rural and Appalachian regions, suffering more than others. The differential regional impact of the crisis in Kentucky—a state with both non-metropolitan/metropolitan and Appalachian/Non-Appalachian statuses—has not yet been documented despite such knowledge being essential to the success of overdose prevention efforts.

Purpose: This study compares all-cause, drug- and opioid-related mortality between counties in different regions of Kentucky: Appalachian non-metropolitan, Appalachian metropolitan, non-Appalachian non-metropolitan, and non-Appalachian metropolitan.

Methods: Age-adjusted mortality data from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER, 2000–2019) were used. County-level demographic and socioeconomic data were obtained from the U.S. Census Bureau, 2010 American Community Survey. Statistical analyses were performed with negative binomial regression models with a log link.

Results: The Appalachian non-metropolitan region of Kentucky had a significantly higher (p < .05) all-cause mortality (1,076/100,000) compared to the state’s non-Appalachian metropolitan (904/100,000), non-Appalachian non-metropolitan (959/100,000), and Appalachian metropolitan (938/100,000) regions. Within non-Appalachian regions, non-metropolitan rates were higher than metropolitan (p = .0006). For drug- and opioid-related mortality, non-metropolitan and metropolitan regions had comparable rates within non-Appalachia, as well as within Appalachia. Appalachian regions had twice the mortality rates of non-Appalachian regions of the state (p < .05). Among the Appalachian counties, non-metropolitan counties had higher all-cause mortality than metropolitan counties.

Implications: The findings from this study can help healthcare practitioners and public health officials develop interventions addressing drug-related and opioid-related mortality in Kentucky targeted to the regions where rates are significantly higher. Also, the information on geographic, demographic, and socioeconomic factors related to these types of mortality can be used to design interventions specific to the target population’s socio-demographics.



Creative Commons License

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

Recommended Citation

Salunkhe SS, Alzahrani S, Ugiliweneza B. Disparities in mortality between Appalachian and non-Appalachian regions of Kentucky. J Appalach Health 2023;5(3):38–52. DOI: https://doi.org/10.13023/jah.0503.04