Using GIS to Compare Areas of Economic, Health, and Social Risk in Appalachia

A recent article in Health Affairs points to widening health disparities between Appalachia and the remainder of the United States. Singh et al. find that disparities in both life expectancy and infant mortality have increased over the last decade and can be attributed to several factors, including higher rates of chronic disease, unintentional injuries, and drug overdoses.

While it’s important to highlight the disparities between Appalachia and the rest of the U.S., we shouldn’t lose sight of the major disparities that also exist within the Appalachia region. Central and southern Appalachia generally have higher rates of poverty and worse health outcomes than other parts of Appalachia. As shown in the map below, higher rates (in darkest blue) of age-adjusted mortality are concentrated in central Appalachia, particularly in eastern Kentucky and southern West Virginia. McDowell County, WV has mortality rates almost 400 percent higher than Union County, PA. Similar patterns exist for a number of other health outcomes, economic indicators, and social determinants.


The map below shows the distribution of Economic Status according to the Appalachian Regional Commission, where counties are categorized as Distressed, At-Risk, Transitional, Competitive, and Attainment based on factors such as poverty, income, and unemployment.  The majority of the Distressed and At-Risk counties are concentrated in central and southern Appalachia.


In order to explore the relationship between poverty and mortality, we combined the two indicators by quartiles – showing the counties in the highest quartile for both poverty and mortality in blue, and the counties in the lowest quartile for both poverty and mortality in yellow. Similar to the patterns above, blue counties are concentrated in central and southern Appalachia.
The Health Affairs article addresses the disparities between Appalachia and the rest of the U.S.  However, it is important to also be aware of the disparities within the Appalachia region, where focusing on the highest need counties is likely to have the largest impact.

All the maps above were created using the Appalachia Data Portal, one of several HealthLandscape mapping tools that are in the process of being updated. For more information about the Appalachia Data Portal, see our previous post that focused on the impact of hospital readmission penalties on safety-net hospitals in Appalachia –

Michael Topmiller, PhD

Health GIS Research Specialist

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