title: Distribution of cardiovascular disease and associated risk factors by county type and health insurance status: results from the 2008 Ohio Family Health Survey.
abstract: OBJECTIVE
  Epidemiologic studies have documented a disproportionate burden of chronic diseases in Appalachia, showing the area to be underserved by the health-care system. Nothing is known about how the health status of the Appalachian population compares with other rural or non-rural populations in the same state. We examined the associations among county type, health insurance category, and health outcomes in poorer adult Ohioans.
  
  
  METHODS
  We obtained data from the 2008 Ohio Family Health Survey, a complex landline- and cell phone-based survey of 50,944 noninstitutionalized households. We constructed bivariate analyses examining health status measures across various insurance categories and metropolitan, suburban, rural, and Appalachian counties in Ohio.
  
  
  RESULTS
  Medicaid enrollees living in Appalachian and rural counties tended to be in poorer health and have a greater prevalence of smoking than non-Medicaid enrollees. Within rural and Appalachian regions, Medicaid enrollees were more likely than non-Medicaid enrollees to have lower self-rated health (54.8%, 95% confidence interval [CI] 44.1, 65.5 in rural regions and 52.1%, 95% CI 44.7, 59.5 in Appalachian regions). Appalachian and rural Medicaid enrollees were at an increased likelihood of having several chronic diseases compared with non-Medicaid enrollees.
  
  
  CONCLUSIONS
  Our findings suggest that rural and Ohio Appalachian Medicaid enrollees were more likely to have hypertension, cardiovascular disease, and overall poorer health than non-Medicaid enrollees. These findings have important policy implications for health-care reform, highlighting regional disparities in provider coverage. These underserved regions would need an increase in the provider base to positively impact proposed Medicaid expansion programs.
authors.affiliation: Ohio Department of Health, Violence and Injury Prevention Program, Columbus, OH ; The Ohio State University, College of Public Health, Columbus, OH.
authors.forename: Mbabazi
authors.initials: M
authors.lastname: Kariisa
authors.affiliation: The Ohio State University, College of Public Health, Columbus, OH.
authors.forename: Eric
authors.initials: E
authors.lastname: Seiber
mesh_terms: D000328:Adult; D001061:Appalachian Region / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D009820:Ohio / Q000453:epidemiology; D011204:Poverty Areas; D015995:Prevalence; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D014481:United States