title: Metropolitan and non-metropolitan trends in coronary heart disease mortality within Appalachia, 1980-1997.
abstract: OBJECTIVE
  In this article, we report on metropolitan and non-metropolitan trends in coronary heart disease (CHD) mortality within the Appalachian Region for the period 1980 to 1997. We hypothesized that trends in CHD mortality would be less favorable in non-metropolitan populations with diminished access to social, economic, and medical care resources at the community level.
  
  
  METHODS
  Our study population consisted of adults aged 35 years and older who resided within the 399 counties of the Appalachian Region between 1980 and 1997. We examined mortality trends for sixteen geo-demographic groups, defined by gender, age, race, and metropolitan status of county of residence. For each geo-demographic group, we calculated annual age-adjusted CHD mortality rates. Line graphs of these temporal trends were created, and log-linear regression models provided estimates of the average annual percent change in CHD mortality from 1980 to 1997. Data on social, economic, and medical care resources for metropolitan vs. non-metropolitan counties were also analyzed.
  
  
  RESULTS
  Rates of CHD mortality were consistently higher in non-metropolitan areas compared with metropolitan areas for blacks of all ages and for younger whites. CHD mortality declined among almost all geo-demographic groups, but rates of decline were slower among non-metropolitan vs. metropolitan residents, blacks vs. whites, women vs. men, and older vs. younger adults. Non-metropolitan areas had fewer socioeconomic and medical care resources than metropolitan areas in 1990.
  
  
  CONCLUSIONS
  Appalachia, particularly non-metropolitan Appalachia, needs policies and programs that will enhance both primary and secondary prevention of CHD, and help diminish racial inequalities in CHD mortality trends.
authors.affiliation: Office for Social Environment and Health Research, Department of Community Medicine, West Virginia University, Morgantown, WV 26506-9190, USA.
authors.forename: E
authors.initials: E
authors.lastname: Barnett
authors.forename: J A
authors.initials: JA
authors.lastname: Halverson
authors.forename: G A
authors.initials: GA
authors.lastname: Elmes
authors.forename: V E
authors.initials: VE
authors.lastname: Braham
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001061:Appalachian Region / Q000453:epidemiology; D044383:Black People; D003327:Coronary Disease / Q000208:ethnology / Q000401:mortality*; D016021:Epidemiologic Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012189:Retrospective Studies; D012424:Rural Population; D014505:Urban Population; D044465:White People; D001741:Black or African American