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UKnowledge > College of Public Health > Journal of Appalachian Health > Vol. 7 (2025) > Iss. 1

 

Corresponding Author

Lyndsey K Blair

lblair3@bellarmine.edu

Author Affiliations

  1. Lyndsey K. Blair, PhD, MPH: Assistant Professorof Healthcare Administration and Public Health; Bellarmine University (Louisville, KY); E-mail: lblair3@bellarmine.edu
  2. Madeline M. Tomlinson: PhD, MPH: Assistant Professor of Healthcare Administration and Public Health; Bellarmine University
  3. Michele Abee Biskis: PhD; Assistant Professor of Environmental Studies; Bellarmine University
  4. Jessica Hume: PhD, MFA: Associate Professor & Department Chair, Healthcare Administration and Public Health; Bellarmine University
  5. Gabri Warren, DNP, RN: Assistant Professor of Nursing; Bellarmine University

Author Area of Expertise

L. Blair - addiction, SDOH, spatial, epidemiology, GIS

M. Tomlinson - epidemiology, spatial, MCH, global

M. Abee - environmental, GIS, geography

G. Warren - nursing, community health, SDOH

J. Hume - health humanities,

Abstract

Introduction: Deaths of despair (DoD), encompassing suicides, drug overdoses, and alcohol-related liver diseases, have emerged as a critical public health crisis in the United States, with their rise particularly pronounced from 1995 to 2013 and exacerbated by the COVID-19 pandemic. Kentucky, grappling with high rates of substance use disorder, poor mental health, and economic hardship, is at the forefront of this issue, particularly in its rural and Appalachian regions.

Purpose: This study explores the social determinants contributing to DoD in Kentucky, focusing on economic and social factors that influence rising rates of suicide, drug overdose, and alcohol-related liver disease. The goal is to provide evidence to guide policy and intervention strategies.

Methods: An ecological study was conducted across 120 Kentucky counties from 2011 – 2020. DoD mortality data were sourced from the CDC WONDER database, and socioeconomic variables from the American Community Survey. Principal Component Analysis (PCA) reduced 10 county-level socioeconomic variables. Poisson regression estimated associations between socioeconomic principal component scores and DoD mortality, adjusting for confounders like age, and racial demographics.

Results: The median DoD mortality rate was 59.7 per 100,000 people, with geographic variation. Three principal components explained 78.4% of the variance in socioeconomic factors. Counties with extreme socioeconomic disadvantages (low education, high poverty, high disability, high unemployment) were strongly associated with higher DoD rates (RR=1.07; 95% CI=1.02-1.12).

Implications: Extreme socioeconomic disadvantage is a key predictor of DoD rates in Kentucky. These findings can inform public health interventions and policy changes targeting high-risk areas, especially rural and Appalachian regions.

DOI

https://doi.org/10.13023/jah.0701.03

Creative Commons License

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

Recommended Citation

Blair LK, Tomlinson MM, Biskis MA, Hume J, Warren G. Heartache in the heartland: unraveling the social roots of deaths of despair in Kentucky. J Appalach Health 2025;7(1):47-62. DOI: https://doi.org/10.13023/jah.0701.03

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