A nonprofit publication of the Kentucky Center for Public Service Journalism

Smoking largely responsible for shorter life spans, higher infant death rates in Appalachia

By Melissa Patrick
Kentucky Health News

People who live in Appalachia are dying sooner than two decades ago, and the region has a higher infant death rate compared to the rest of the nation.

A new study blames both largely on the region’s high smoking rate, as well as its other bad health habits.

“What this report shows is the extreme damage that tobacco is causing our people, and how we are getting hammered by it worse than any other place in this country,” said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky.

The study, published in the academic journal Health Affairs, compared infant mortality and life expectancy disparities in Appalachia to the rest of the United States between 1990 and 2013, using national vital statistics data.

It found that Appalachia and the rest of the nation had similar rates for infant morality and life expectancy in the 1990s, but by 2013 infant mortality was 16 percent higher in Appalachia, and adults in the region were living 2.4 fewer years than people who lived in the rest of the country: 76.9 and 79.3 years, respectively.

The study attributes these widening gaps to “persistent or increasing disparities in general living standards and health-risk behaviors such as adult smoking, smoking during pregnancy, obesity, physical inactivity, and heavy consumption of alcohol.”

Heart disease, lung cancer and other respiratory diseases were among the leading causes of death in the Appalachian region during the study period, all conditions that can be caused by smoking.

“We are the cancer-mortality capital of the nation right now, and we just cannot let that stand,” Chandler said. “If we truly want to change Kentucky’s health statistics, the single most effective thing we can do is to reduce our smoking rates.”

Kentucky has the highest smoking rate in the nation, 26 percent of adults. But smoking affects children, even those who don’t smoke. Smoking during pregnancy is a risk factor for both birth defects and SIDS, according to the federal Centers for Disease Control and Prevention.

While the number of Kentucky mothers who smoked during pregnancy dropped from 26 percent in 2006 to almost 20 percent in 2015, this is still significantly higher than the national rate of 8 percent. Overall smoking rates and pregnancy smoking rates are highest in the state’s Appalachian counties.

The report says the higher rates of birth defects and Sudden Infant Death Syndrome deaths in Appalachia accounted for 60 percent of the difference in infant mortality between the region and the rest of the country in 2009-13. Other contributors included diabetes, kidney diseases, suicide, unintentional injuries (such as traffic accidents) and drug overdoses.

There could be other causes for the increasing disparity. The researchers said it is possible that more affluent, healthier Appalachian residents may have migrated to more urban and affluent areas of the U.S., thus increasing the health and economic inequalities between the region and the rest of the nation.

They called for policies that address the region’s high smoking rates, high unemployment rates, low education levels, poor access to health care, high obesity rates, transportation and housing issues, and try to increase access to healthy foods, to decrease the current gaps in health outcomes.

“Given the national gains in life expectancy, seeing the increasing disparity between Appalachia and the rest of the United States should serve as a wake-up call,” Rebecca Slifkin, co-author of the study said in a news release. “Many of the reasons for the disparities we observe are due to differences in social determinants of health.

“We really need new investments to ensure that health is not determined by where one lives. As a society, we invest huge sums in medical care to extend an individual’s life; imagine the gains we could make if similar resources were devoted to public health.”

The study used the 2008 Appalachian Regional Commission definition of Appalachia, which covers 428 counties in 13 states, 54 in Kentucky.

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