Comparing Child Health, Access to Care, and Utilization of Health Services Between Ohio Appalachia’s River and Non-River Bordering Counties

Abstract

Appalachia’s River and non-River Bordering Counties. Children living in Ohio’s Appalachian counties that border the Ohio River are disproportionally exposed to adverse environmental conditions prevalent along the river that may contribute to disparities in health, access to care and care utilization. This study examined if there were differences in health, access to care and care utilization between Ohio’s Appalachian children living in counties that border the Ohio River and those living in counties that do not border the river. A secondary analysis of the 28 Appalachian counties from Ohio’s 88 counties included in the 2008 Ohio Family Health Survey was conducted using a Bayesian Hierarchical Modeling strategy. Descriptive analyses comparing geographic groups across demographic, health, access, utilization, and health insurance also were conducted. Childhood asthma was more prevalent in the river-bordering counties (16.4%) compared to the non-river counties (9.4%). Children with asthma had more sere symptoms in the river bordering counties (8.2%) compared to the non-river bordering counties (4.4%). Children residing in river bordering counties had higher rates of obesity (24.4%) and overweight (17%). After controlling for child health and insurance status, children living in the river bordering counties had less access to care (est. −7.14, CI = −17.3,0.74) and more difficulty accessing specialty care. Children residing in the non-river counties had more sickness care utilization (est. 0.25, CI = 0.01, 0.49). Regardless of region, children with a regular health care provider and place for care were healthier. Differences in child health, access to care and utilization of services exist within Ohio’s Appalachian region.