Citation/Abstract

The purpose of this longitudinal trend analysis was to document the extent of disparities in access to health care, use of preventive health services, and practice of health-related behaviors between Appalachian and Non-Appalachian adults in Kentucky over a 6-year period. The specific aims were to: (a) examine trends in health insurance coverage, ability to pay for health services, and difficulty with travel to a health facility using the Kentucky Health Interview Survey (KHIS) data; (b) examine preventive health service trends, specifically Pap smears for women and dental visits by adults, using KRIS data; (c) examine physical activity level, body mass index (BMI), and cigarette use using the Behavioral Risk Factor Surveillance System (BRFSS) data; and (d) investigate potential disparities overtime by sex of the participants and area of residence.

A longitudinal trend design using secondary data from the KHIS and BRFSS databases was used to examine disparities from 1992 to 1997. Area of residence predicted the probability of difficulty in travel to a health facility, χ 2 (1, N = 3,881) = 151.86, p ≤ .0001. Non-Appalachians had less difficulty traveling to a health facility compared with Appalachians (Odds Ratio = .47). Difficulty with travel to a health facility was less likely for those who had at least a high school education compared with those who had not completed high school (Odds Ratio = .56), and for those with an income >$25,000 compared with those who had lower incomes (<$25,000) (Odds Ratio = .52). Multiple regression revealed differences in Body Mass Index (BMI) for years 1996 (p < .0001) and 1997 (p < .0001). Appalachians (M = 26.14, SE = .08) had a greater BMI than Non-Appalachians (M = 25.59, SE = .04). The interaction between Region x Year revealed Non-Appalachian men had a greater mean BMI in 1997 compared with Appalachian men, a reversing trend in time.

Some disparities exist between Appalachians and Non-Appalachians in Kentucky and have not changed over time. Compared with Non-Appalachians, Appalachians have lower education and income, and greater unemployment creating barriers to access to health care and they use fewer preventive health services and practice fewer health-related behaviors.