Death comes sooner in Appalachia. It comes much sooner in Eastern Kentucky.
The years of life Appalachian Kentucky residents lose to health maladies such as heart disease and cancer is 63 percent higher than the national average, according to a report released Thursday.
The news was not good in Eastern Kentucky and other parts of Appalachia on just about every indicator of health: heart disease deaths were 17 percent higher in Appalachia than the country as a whole; cancer deaths were 27 percent higher; stroke deaths were 14 percent higher; and the rate of deaths from poisoning, which mostly means from drug overdoses, was 37 percent higher.
Put all that together, and the years of potential life lost before age 75 — a measure of premature death — was 25 percent higher in Appalachia than in the U.S, the report found.
The measures were even worse for the Kentucky counties defined as part of the region.
There, heart disease deaths ran 45 percent over the national rate and 32 percent higher than in the rest of Kentucky, for example, and cancer mortality was 35 percent higher than in the U.S, according to a summary from the Appalachian Regional Commission.
The rate of deaths from poisoning in Kentucky’s Appalachian counties was 141 percent higher than the national figure, and 68 percent over the rest of the state, according to the report.
Kentucky’s Appalachian counties, which have been ravaged by abuse of prescription pain pills, had the highest poisoning-death rate in Appalachia.
Appalachia includes all of West Virginia and parts of 12 other states from Mississippi to New York. The region takes in 54 counties in Kentucky, including the Eastern Kentucky coalfield and farming counties in the southern part of the state.
There are metro areas in that giant region, but nearly all the Kentucky counties are rural and most are classified as economically distressed.
Ben Chandler, president of the Foundation for a Healthy Kentucky, said one takeaway from the report was not just how poorly Appalachia fared in health measures compared to the nation, but that Appalachian Kentucky ranked even worse.
“The policymakers in the state need to understand we’re behind everyone else, including Appalachia,” Chandler said of Eastern Kentucky. “That’s the thing that’s so stark.”
The foundation was a primary participant in the report along with the Robert Wood Johnson Foundation and the ARC.
The report looked at 20-year trends for some health indicators, showing improvements in Appalachia on a number of measures, including deaths from strokes, heart disease and cancer, and a decline in infant deaths.
U.S. Rep. Hal Rogers, a Republican who represents Appalachian Kentucky, said it was encouraging to see those improvements despite longstanding health challenges in the area. He credited the work of communities, hospitals, colleges and universities.
“Every life saved sparks hope for us to continue the work of advancing health care, education and other measures that improve the quality of life for people living and working in Kentucky’s Appalachian region,” he said.
Rogers has had federal health leaders come to Eastern Kentucky several times to learn of the challenges and offer expertise.
Even with the improved outcomes, however, the region did not gain as much ground as the rest of the country, meaning the gap between Appalachia and the country widened.
For example, cancer deaths in the country declined by 21 percent when comparing 1989 through 1995 with 2008 through 2014, but only went down in Appalachia by 14 percent, the report said.
That meant that during 1989-95, the cancer death rate in Appalachia was only 1 percent higher than in the country, but that gap grew to 10 percent in 2008-14, according to a news release with the report.
The gap in infant mortality grew from 4 percent to 16 percent higher in Appalachia in those two periods, the study found.
“The U.S. can’t be healthy as a whole if we are leaving whole regions behind,” said Hilary Heishman, senior program officer with the Robert Wood Johnson Foundation.
Earl F. Gohl, the federal co-chairman of the ARC, said the report was an important step in identifying the health challenges facing Appalachia.
“Now we need to understand the implications these findings have for Appalachia’s economy so we can continue working towards a brighter future for the region,” Gohl said.
The report used the most recent data from a number of sources, with mortality statistics from 2008 through 2014, according to the ARC. It did not include information from 2015 or beyond.
There were some bright spots in the findings, which also included socioeconomic data.
For instance, the report found there was less reported excessive drinking in Appalachian Kentucky; the rate of human immunodeficiency virus (HIV) was 82 percent less than in the nation; and the ratio of students to teachers in the area, at 15.4, was lower than the average of 16.5 for Kentucky and the nation.
The report highlighted factors that play a role in the poor health rankings for Appalachian Kentucky, including higher poverty and unemployment, higher smoking rates and people being less physically active, which contributes to higher rates of obesity, diabetes and other problems.
For example, 25.9 percent of the adults in that area reported smoking, compared to 16.3 percent nationally, and 32.8 percent of residents reported being physically inactive, compared to 23.1 percent nationally.
Access to health care also is a factor.
Tens of thousands of people in Kentucky’s Appalachian counties became eligible for health care under Medicaid because of an expansion of the program under the federal Affordable Care Act, also called Obamacare.
However, 18.6 percent of the people in Appalachian Kentucky under age 65 were uninsured during the period covered in the study, compared to 16.8 percent nationally.
In Kentucky as a whole, the uninsured rate was slightly lower than the national level.
The study also found that the number of primary care doctors in Kentucky’s Appalachian region was 26 percent lower than in the U.S. and the number of specialty physicians was 59 percent lower.
Chandler said tackling the problem of poor health in Appalachian Kentucky can seem daunting, but that it’s possible to make progress by pursuing targeted strategies.
The foundation believes the single most effective step to improve health would be to reduce smoking rates, for instance. That can be accomplished through wider adoption of laws to bar smoking in public places and a higher tax on cigarettes, and neither would require more state spending, Chandler said.
“If there ever was a call for policymakers to step up and look for a solution to these problems, it’s this report,” he said. “There are some things that can make a difference.”