The Early Deaths of Appalachians

The region is falling behind the rest of America in life expectancy and infant mortality, a new study finds.

A woman smokes in West Virginia.
A woman smokes in West Virginia. ( Lexi Browning / Reuters)

At the Reger Funeral Home and Chapel in Huntington, West Virginia, owner Patrick Reger says he increasingly sees 50-somethings dying of diseases—like cirrhosis of the liver or lung cancer—that used to mostly kill 80-somethings.

There seems to be an uptick young people drinking heavily and using drugs. “There’s just a lack of employment for people,” he said. “That’s where you find the problems with the drugs. There’s nothing to do.”

The trend he’s seen is playing out across the region: Appalachia, the mountainous region home to about 8 percent of Americans, is falling behind the rest of the United States in life expectancy and infant mortality, according to a new study in Health Affairs.

For the study, the authors, Gopal Singh and Michael Kogan from the Health Resources and Services Administration and Rebecca Slifkin from the University of North Carolina at Chapel Hill, compared deaths data from the period between 1990 and 1992 and between 2009 and 2013, the most recent years available, in the swath of 428 counties that make up Appalachia. They examined life expectancy and infant mortality—two well-established measures of overall public health.

Appalachian counties and their economic status in 2008, the year used by the Health Affairs study authors. (Appalachian Regional Commission)

In the early ’90s, the study authors found, the region’s infant mortality rate was about identical to that of the rest of the country, but between 2009 and 2013, it was 16 percent higher. Similarly, in 1992, the average Appalachian had a life expectancy of about 75.2 years, just half a year shorter than the average American. By the 2009 to 2013 study period, the disparity had grown to 2.4 years. In the intervening time—nearly two decades that saw the advent of DNA sequencing and other medical advancements—life expectancy increased by 2.4 years for women outside of Appalachia, but by just a fraction of a year for Appalachian women.

The numbers are even starker when stratified by race. In the most recent years studied, a black man in Appalachia could expect to die about three years earlier than a white man in Appalachia and a year younger than a black man elsewhere. A black man living in a high-poverty area in Appalachia could expect to die a full 13 years younger than a typical white woman in a low-poverty area elsewhere in America. That’s roughly the life expectancy difference between the United States and Rwanda.

Health Affairs

Most of this gap is attributable to deaths among people younger than 65. Half of the life-expectancy gap is attributable to smoking, and another 6 percent could be explained by drug overdoses. The rest of the gap could be explained, in large part, by ailments like cancer and heart disease—to which poor nutrition and obesity can contribute.

“For all of these things—obesity, smoking, and health-care access—the disparities between Appalachia and the rest of the country have been growing,” Singh said.

To him, the poor health is a symptom of joblessness, social isolation, and the attendant psychological distress. “Calorie-dense foods are much less expensive, and they tend to be less healthy, which then contributes to obesity, which contributes to an increased risk of hypertension,” Kogan said. And that, in turn, increases a pregnant woman’s risk of having her infant die.

This study echoes other recent findings that paint a bleak view of the health of low-income Americans. American life expectancy recently declined for the first time since 1993, the height of the AIDS epidemic. One recent paper showed the eight counties with the largest declines in life expectancy since 1980 are all in the state of Kentucky.

Zeb Hampton, manager at the J.W. Call funeral home in Pikeville, Kentucky, said recently young people have been leaving the region to go to college—and never coming back. Among those who stay, some fall into unhealthy habits, like smoking, a poor diet, and drugs. He’s seen more 30-, 40-, and 50-somethings dying of overdoses in the past five years. Many of the victims lack life insurance, he said, so the families struggle to pay for the funeral—a problem Reger said is common in Huntington, as well.

“It used to be families would all pitch in and help take care of a funeral service,” Reger said. “Their incomes are so limited that they don’t have that ability anymore. They want to take care of their loved ones, so they do the best they can.”