Distribution of Cardiovascular Disease and Associated Risk Factors by County Type and Health Insurance Status: Results from the 2008 Ohio Family Health Survey

Abstract

Objectives. Epidemiologic studies have documented a disproportionate burden of chronic diseases in Appalachia, showing the area to be underserved by the health-care system. Nothing is known about how the health status of the Appalachian population compares with other rural or non-rural populations in the same state. We examined the associations among county type, health insurance category, and health outcomes in poorer adult Ohioans.Methods. We obtained data from the 2008 Ohio Family Health Survey, a complex landline-and cell phone-based survey of 50,944 noninstitutionalized households. We constructed bivariate analyses examining health status measures across various insurance categories and metropolitan, suburban, rural, and Appalachian counties in Ohio.Results. Medicaid enrollees living in Appalachian and rural counties tended to be in poorer health and have a greater prevalence of smoking than nonMedicaid enrollees. Within rural and Appalachian regions, Medicaid enrollees were more likely than non-Medicaid enrollees to have lower self-rated health (54.8%, 95% confidence interval [CI] 44.1, 65.5 in rural regions and 52.1%, 95% CI 44.7, 59.5 in Appalachian regions). Appalachian and rural Medicaid enrollees were at an increased likelihood of having several chronic diseases compared with non-Medicaid enrollees.Conclusion. Our findings suggest that rural and Ohio Appalachian Medicaid enrollees were more likely to have hypertension, cardiovascular disease, and overall poorer health than non-Medicaid enrollees. These findings have important policy implications for health-care reform, highlighting regional disparities in provider coverage. These underserved regions would need an increase in the provider base to positively impact proposed Medicaid expansion programs.

Geographic distribution of insufficient sleep across the United States: a county-level hotspot analysis

“…There have been a number of studies of this region that have shown that Appalachia is a region that has one of the highest obesity rates in the nation. 28,29 In addition, individuals living in this region are at greater risk for cardiovascular disease 30,31 , diabetes 20,21 , lung diseases 32–34 , and several types of cancer 30,32,33,35 , relative to individuals in other areas. Some reasons for this may be the general lack of education in this region, low socioeconomic status, unemployment, lack of access to care, and lack of infrastructure.…”

Rural‐Urban Differences in Alzheimer's Disease and Related Disorders Diagnostic Prevalence in Kentucky and West Virginia

“…Such procedures, including even basic brain imaging, may not be available in many rural areas, and more advanced diagnostic procedures such as PET are typically only available in specialized academic research centers. Moreover, higher prevalence of multimorbidity in rural populations may leave rural clinicians with limited time to assess patients for emerging cognitive dysfunction using even routine bedside assessment tools.…”

The Association between Health Insurance and All-Cause, Cardiovascular Disease, Cancer and Cause-Specific Mortality: A Prospective Cohort Study

“…Although private insurance was associated with decreased mortality risk, public insurance was associated with increased mortality risk. The mechanisms have been extensively studied for how health insurance affects mortality [4,[30][31][32][33]. Previous studies have shown that socioeconomic factors, lifestyle factors, and getting care when needed played an important part in the mechanism [21,33].…”