Driscoll David L, O'Donnell Hannah, Patel Maitri, Cattell-Gordon David C
Healthy Appalachia Institute, UVA Wise.
UVA Health.
J Appalach Health. 2023 Dec 1;5(3):85-102. doi: 10.13023/jah.0503.07. eCollection 2023.
Residents of Appalachia experience elevated rates of morbidity and mortality compared to national averages, and these disparities are associated with inequitable exposures to various determinants of population health. Social and environmental determinants of health are a useful lens through which to develop and evaluate programs to mitigate regional health disparities.
This 2023 scoping review was conducted of studies linking determinants of Appalachian health with leading causes of regional mortality and morbidity. The search strategy employed a keyword search that included geographic terms for the Appalachian Region and the primary adverse health outcomes in that region. Studies meeting the following inclusion criteria were reviewed: original article, published in the last five years, involving an Appalachian population, and includes a rigorous assessment of an association between a population health determinant and one or more leading causes of Appalachian morbidity and mortality.
The search returned 221 research articles, including 30 interventional studies. The top three health outcomes included cancer (43.59%), diseases of despair (23.08%), and diabetes (12.82). Access to care (27.3%), rurality (18.9%), and education (14.8%) were the most common population health determinants identified. Interventional studies were categorized by program types: education, technology, partnerships, and multilevel interventions. Due to the heterogeneity of study types, the studies were combined using a narrative synthesis.
The results of this work can inform the development and evaluation of additional programs to promote Appalachian population health. Our study team will use these results to inform community-based discussions that develop strategic plans to mitigate health disparities in Central and Southcentral Appalachian Virginia.
与全国平均水平相比，阿巴拉契亚地区居民的发病率和死亡率较高，这些差异与人口健康的各种决定因素的不公平暴露有关。健康的社会和环境决定因素是制定和评估减轻地区健康差异计划的有用视角。
本2023年的范围综述对将阿巴拉契亚健康决定因素与该地区主要死亡和发病原因联系起来的研究进行了梳理。检索策略采用关键词搜索，包括阿巴拉契亚地区的地理术语和该地区的主要不良健康结果。对符合以下纳入标准的研究进行了综述：过去五年发表的原创文章，涉及阿巴拉契亚人群，并且包括对人口健康决定因素与阿巴拉契亚发病和死亡的一个或多个主要原因之间关联的严格评估。
检索返回221篇研究文章，包括30项干预性研究。前三大健康结果包括癌症（43.59%）、绝望疾病（23.08%）和糖尿病（12.82%）。获得医疗服务（27.3%）、农村地区（18.9%）和教育（14.8%）是确定的最常见的人口健康决定因素。干预性研究按项目类型分类：教育、技术、伙伴关系和多层次干预。由于研究类型的异质性，采用叙述性综合法对研究进行合并。
这项工作的结果可为促进阿巴拉契亚人口健康的其他计划的制定和评估提供参考。我们的研究团队将利用这些结果为基于社区的讨论提供信息，这些讨论将制定战略计划以减轻弗吉尼亚州中阿巴拉契亚和中南阿巴拉契亚的健康差异。
