Research Finds that Appalachia’s Diseases of Despair Mortality Rates Continue to be Higher than the Rest of Nation

JOHNSON CITY, TN—Appalachian Diseases of Despair, a new report from the Appalachian Regional Commission finds that despite overall declining mortality rates from diseases of despair (overdose, suicide, and liver disease) between 2017-2018, the Region’s diseases of despair mortality rate in 2018 was still 36 percent higher than the rate for the non-Appalachian United States. Moreover, among Appalachians in the prime working ages of 25-54, the diseases of despair mortality rate was 43 percent higher in the Region than the rest of the country. The report also found that for women, the diseases of despair mortality rate was 46 percent higher in the Appalachian Region than in the rest of the country; while for men, the diseases of despair mortality rate was 31 percent higher in the Region versus the rest of the country.

“The ongoing disparities within Appalachia related to diseases of despair have broad impacts on our Region’s children, families, and our communities,” says Michael Meit, director of research and programs for ETSU’s Center for Rural Health Research and NORC senior fellow, who led the research study. “While mortality rates declined in 2018, we know that COVID-19 has created new stressors that are once again resulting in spikes in deaths due to diseases of despair. We need to leverage the strength, resilience, and creativity of our Appalachian people to make sure that progress made in 2018 is not fleeting.”

The report, which was released today as part of National Rural Health Day, found that in 2018:

West Virginia and the Appalachian counties of Maryland had the highest diseases of despair mortality rates among all Appalachian states, while the Appalachian portions of Mississippi, Georgia, and New York had the lowest. In Appalachian Maryland, West Virginia, Appalachian Ohio, and Appalachian Pennsylvania, at least 60 percent of diseases of despair deaths were due to overdose.

The states with the highest percentages of overdose deaths attributed to opioids within their Appalachian counties were Maryland (92 percent), West Virginia (83 percent), North Carolina (81 percent), Ohio (78 percent), and Virginia (76 percent). The states with the lowest percentage of overdose deaths attributed to opioids were Appalachian Mississippi (45 percent) and Appalachian Alabama (54 percent).

While the rate of overdose deaths was greater in metro counties in Appalachia, the rates of suicide and liver disease were higher in non-metro counties.

Anticipating the impact the pandemic and other events may have on future findings, the report notes that “The impact of COVID-19 will likely lead to an increase in mortality from diseases of despair, particularly as the Appalachian Region and the rest of the United States experience economic challenges as a result of the pandemic, isolation, and limitations on access to in-person treatment and recovery support. It will be important to continue to monitor these trends in diseases of despair mortality in the Appalachian Region.”

Appalachian Diseases of Despair research was conducted by the Walsh Center for Rural Health Analysis at NORC at the University of Chicago and the Center for Rural Health Research at East Tennessee State University, and draws on 2018 mortality data from the Centers for Disease Control and Prevention. The report is a follow-up to similar research released in 2017 when the United States was seeing a dramatic rise in overdose deaths from synthetic opioids, particularly those involving illicitly manufactured fentanyl.

About the Walsh Center for Rural Health Analysis

NORC’s Walsh Center for Rural Health Analysis, established in 1996, conducts timely policy analysis, research, and evaluation that address the needs of policymakers, the health care workforce, and the public on issues that affect the health and well-being of rural Americans. The Walsh Center is part of NORC at the University of Chicago, an objective, non-partisan research institution that delivers reliable data and rigorous analysis to guide critical programmatic, business, and policy decisions.

About ETSU’s Center for Rural Health Research

Founded in 2019, the Center for Rural Health Research is housed within the East Tennessee State University College of Public Health. The Center works in partnership with local, regional, statewide and national organizations, and topic-area experts, to identify and study innovations to improve health and enhance the quality of life of people living in rural communities across Tennessee, Central Appalachia, and around the nation.

Contact: For more information, contact Eric Young at NORC at or (703) 217-6814 (cell); or Melissa Nipper at ETSU at or (859) 489-1696 (cell).