Investigating the impact of the diseases of despair in Appalachia

Abstract

Introduction Appalachia is one of the regions most significantly impacted by the opioid crisis. This study investigated mortality due to diseases of despair within the Appalachian Region, with an additional focus on deaths attributable to opioid overdose. Methods Diseases of despair include: alcohol, prescription drug and illegal drug overdose, suicide, and alcoholic liver disease/cirrhosis of the liver. Mortality data from the National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS) Multiple Cause of Death database were analyzed for this study, focusing on individuals aged 15–64. Results Over the past two decades, the mortality rate due to diseases of despair has been increasing across the United States, but the gap has widened between the Appalachian Region and the rest of the nation. In 2017, the combined diseases of despair mortality rate was 45% higher in the Appalachian Region than the non-Appalachian United States. When looking at just overdose mortality, this disparity grows to 65% higher in the Appalachian Region. Within the Appalachian region disparities are most notable in the Central and North Central Appalachian subregions, among males, and among individuals age 45 to 54. Discussion These findings document the scale and scope of the problem in Appalachia and highlight the need for additional research and discussion in terms of effective interventions, policies, and strategies to address these diseases of despair. Over the past two decades, mortality from overdose, suicide, and alcoholic liver diseases/cirrhosis has increased across the United States, but the disparity between Appalachia and the non-Appalachian U.S. continues to grow.

Icelandic Prevention Model for Rural Youth: A Feasibility Study in Central Appalachia

“…Furthermore, declining economic opportunities coupled with high rates of occupational injury and chronic pain have contributed to a substance misuse epidemic, particularly nonmedical use of prescription opioids and heroin, in this region (Moody et al, 2017). Substance misuse in the region has contributed to increasing rates of drug overdose (licit and illicit), suicide, hepatitis C virus (Zibbell et al, 2015), and alcoholic liver disease (Meit et al, 2019). Collectively, these conditions have been referred to as "diseases of despair" (Meit et al, 2019).…”

“…Substance misuse in the region has contributed to increasing rates of drug overdose (licit and illicit), suicide, hepatitis C virus (Zibbell et al, 2015), and alcoholic liver disease (Meit et al, 2019). Collectively, these conditions have been referred to as "diseases of despair" (Meit et al, 2019). Age-adjusted mortality rates from diseases of despair among individuals aged 15 to 64 years were highest in Central (94.4 per 100,000) and North Central (88.6 per 100,000) Appalachia compared with the entire Appalachian (66.6 per 100,000) and non-Appalachian (48.6 per 100,000) regions of the United States in 2015 (Meit et al, 2019).…”

“…Collectively, these conditions have been referred to as "diseases of despair" (Meit et al, 2019). Age-adjusted mortality rates from diseases of despair among individuals aged 15 to 64 years were highest in Central (94.4 per 100,000) and North Central (88.6 per 100,000) Appalachia compared with the entire Appalachian (66.6 per 100,000) and non-Appalachian (48.6 per 100,000) regions of the United States in 2015 (Meit et al, 2019). These mortality rates were highest in the most rural parts of Appalachia.…”

“…For instance, small population sizes, limited resources, failure of community leaders to connect health outcomes with policy, and cultural differences have been observed as barriers to previous intervention efforts ( Barnidge et al, 2013). The ongoing opioid epidemic highlights the need for new policies and culturally adaptable interventions to prevent substance use initiation in Central Appalachia (Meit et al, 2019). However, no studies have explored the unique barriers to implementing community-engaged primary prevention interventions such as the IPM in rural West Virginia, which is the only state that lies entirely within the Appalachian region.…”

Rural Appalachia Battling the Intersection of Two Crises

“…While rates had declined, drug overdose mortality rates in Appalachia remained 48% higher than the national average in 2018, the most recent year of data available. 1 Since that time, early data from the Centers for Disease Control and Prevention (CDC) show rising drug overdose mortality rates nationally, and anecdotally, partners in Appalachia attribute those most recent trends to the impact of COVID-19.…”