Presenter Information

Richard R. Trosper, DepaulFollow

Start Date

22-3-2019 10:00 AM

End Date

22-3-2019 11:00 AM

Description

Persistent Appalachian Health Disparities: An Integrative Literature Review

Richard Trosper

Research Sponsor: Elizabeth P Anderson RN, PhD

Background: The area surrounding the Appalachian Mountains is referred to as Appalachia. There are 420 counties in 13 states which are considered to be part of the Appalachian region (Shapiro, 2001). Despite the progress made by the Kennedy and Johnson administrations, health in Appalachia still falls far behind that of other parts of America (Widner, 1990). This disparity has been termed and utilized in research in the realm of limited health care access, different diseases, and health related problems confused with the complexity of the Appalachian geographical remoteness and possible outcomes of poverty.

Purpose To conduct an integrative literature review with a summation prioritization and synthesis of present detrimental factors and what are the leading illnesses that contribute to this term of healthcare disparities of the Appalachian counties and people.

Objectives: To explore the persistent health outcome gaps in Appalachia and the barriers to better health outcomes for Appalachian Americans. ?? this is what was written in the first chapter purpose: present detrimental factors and what are the leading illnesses that contribute to this term of healthcare disparities of the Appalachian counties and people.

Methods: An integrative literature review designed to systematically examine the existing literature to uncover any gaps in the knowledge base. The review of literature was guided using the framework constructed by Whittemore and Knafl (2005). Eight research studies were examined and analyzed from 2014 to 2018.

Results: Common themes were found; cancer outcome, association of poverty, and associations intimate partner violence hospitalization. Cancer outcome: Glioblastoma Brain Cancer (GBC) with Appalachians who were found to have a lower life expectancy and cure rate than the rest of United States (US). The 1-year survival rate was tied to the method of treatment chosen by the physician. The physician’s decision was influenced by perceived outcome and ability to be reimbursed for surgical procedures. Mood test significant difference in survival only between patient underwent GTR and biopsy patients (-<0.00001). GTR highest 1-year survival rate 64%; STR 41%, biopsy 10%. Long rank test showed survival distribution of groups over time significantly different (p<0.0001). Patients >60 years of age were more likely to have brain biopsies to decrease further aggressive treatment/surgeries and were more likely to be referred to palliative care. Ages groups (GBD) also effected were from 20 to 59 years of age (40.3%). Little difference was found between the two: coal mining community verses non-coal mining communities; suggesting that mortality rates in Appalachia have little to do with ecological factors. Association of Poverty: Higher infant mortality was in Appalachia. Less access to clinics due to low economic status therefore impacted availability of programs to promote health. Obesity, diabetes and smoking were other co-morbidities found. Byproducts of coal mining was not found to be a risk factor. Association intimate partner violence (IPV): (IPV) impacted more hospitalizations than rest of US. There was an effect on health issues such as depression and suicide. Almost 2/3 of patients hospitalized for IPV in Appalachia lived in communities with the lowest annual income quartile $38999. Major limitation was the lack of a theoretical framework to guide the 87.5% (1/8) of the studies.

Conclusion: After conducting an integrative literature review analyzing eight studies, the findings support the existence of numerous barriers to the health and wellbeing and mortality rates of the Appalachian community and region. The region itself, by county, has a lower annual income on average than the rest of the United States prompting a lack of resources available for health services on the county level. This has led to a lower level of healthcare funding for the Appalachian counties and a lower rate of primary care providers at the county level. Future research is recommended into the variables found in this integrative literature review with the guidance of the Social Ecological framework theoretical model by Bronfenbrenner (1999).

Keywords: health outcomes, mortality, longevity, disparities, inequalities, inequality, inequity, or inequities.

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Mar 22nd, 10:00 AM Mar 22nd, 11:00 AM

Persistent Appalachian Health Disparities: An Integrative Literature Review

Persistent Appalachian Health Disparities: An Integrative Literature Review

Richard Trosper

Research Sponsor: Elizabeth P Anderson RN, PhD

Background: The area surrounding the Appalachian Mountains is referred to as Appalachia. There are 420 counties in 13 states which are considered to be part of the Appalachian region (Shapiro, 2001). Despite the progress made by the Kennedy and Johnson administrations, health in Appalachia still falls far behind that of other parts of America (Widner, 1990). This disparity has been termed and utilized in research in the realm of limited health care access, different diseases, and health related problems confused with the complexity of the Appalachian geographical remoteness and possible outcomes of poverty.

Purpose To conduct an integrative literature review with a summation prioritization and synthesis of present detrimental factors and what are the leading illnesses that contribute to this term of healthcare disparities of the Appalachian counties and people.

Objectives: To explore the persistent health outcome gaps in Appalachia and the barriers to better health outcomes for Appalachian Americans. ?? this is what was written in the first chapter purpose: present detrimental factors and what are the leading illnesses that contribute to this term of healthcare disparities of the Appalachian counties and people.

Methods: An integrative literature review designed to systematically examine the existing literature to uncover any gaps in the knowledge base. The review of literature was guided using the framework constructed by Whittemore and Knafl (2005). Eight research studies were examined and analyzed from 2014 to 2018.

Results: Common themes were found; cancer outcome, association of poverty, and associations intimate partner violence hospitalization. Cancer outcome: Glioblastoma Brain Cancer (GBC) with Appalachians who were found to have a lower life expectancy and cure rate than the rest of United States (US). The 1-year survival rate was tied to the method of treatment chosen by the physician. The physician’s decision was influenced by perceived outcome and ability to be reimbursed for surgical procedures. Mood test significant difference in survival only between patient underwent GTR and biopsy patients (-<0.00001). GTR highest 1-year survival rate 64%; STR 41%, biopsy 10%. Long rank test showed survival distribution of groups over time significantly different (p<0.0001). Patients >60 years of age were more likely to have brain biopsies to decrease further aggressive treatment/surgeries and were more likely to be referred to palliative care. Ages groups (GBD) also effected were from 20 to 59 years of age (40.3%). Little difference was found between the two: coal mining community verses non-coal mining communities; suggesting that mortality rates in Appalachia have little to do with ecological factors. Association of Poverty: Higher infant mortality was in Appalachia. Less access to clinics due to low economic status therefore impacted availability of programs to promote health. Obesity, diabetes and smoking were other co-morbidities found. Byproducts of coal mining was not found to be a risk factor. Association intimate partner violence (IPV): (IPV) impacted more hospitalizations than rest of US. There was an effect on health issues such as depression and suicide. Almost 2/3 of patients hospitalized for IPV in Appalachia lived in communities with the lowest annual income quartile $38999. Major limitation was the lack of a theoretical framework to guide the 87.5% (1/8) of the studies.

Conclusion: After conducting an integrative literature review analyzing eight studies, the findings support the existence of numerous barriers to the health and wellbeing and mortality rates of the Appalachian community and region. The region itself, by county, has a lower annual income on average than the rest of the United States prompting a lack of resources available for health services on the county level. This has led to a lower level of healthcare funding for the Appalachian counties and a lower rate of primary care providers at the county level. Future research is recommended into the variables found in this integrative literature review with the guidance of the Social Ecological framework theoretical model by Bronfenbrenner (1999).

Keywords: health outcomes, mortality, longevity, disparities, inequalities, inequality, inequity, or inequities.