title: Assessment of Factors Contributing to Health Outcomes in the Eight States of the Mississippi Delta Region.
abstract: BACKGROUND
  The objective of this observational study was to examine the key contributors to health outcomes and to better understand the health disparities between Delta and non-Delta counties in 8 states in the Mississippi River Delta Region. We hypothesized that a unique set of contributors to health outcomes in the Delta counties could explain the disparities between Delta and non-Delta counties.
  
  
  METHODS
  Data were from the 2014 County Health Rankings for counties in 8 states (Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee). We used the Delta Regional Authority definition to identify the 252 Delta counties and 468 non-Delta counties or county equivalents. Information on health factors (eg, health behaviors, clinical care) and outcomes (eg, mortality) were derived from 38 measures from the 2014 County Health Rankings. The contributions of health factors to health outcomes in Delta and non-Delta counties were examined using path analysis.
  
  
  RESULTS
  We found similarities between Delta counties and non-Delta counties in the health factors (eg, tobacco use, diet and exercise) that significantly predicted the health outcomes of self-rated health and low birthweight. The most variation was seen in predictors of mortality; however, Delta counties shared 2 of the 3 significant predictors (ie, community safety and income) of mortality with non-Delta counties. On average across all measures, values in the Delta were 16% worse than in the non-Delta and 22% worse than in the rest of the United States.
  
  
  CONCLUSIONS
  The health status of Delta counties is poorer than that of non-Delta counties because the health factors that contribute to health outcomes in the entire region are worse in the Delta counties, not because of a unique set of health predictors.
authors.affiliation: University of Wisconsin Population Health Institute, 575C WARF Office Building, 610 Walnut St, Madison, WI 53726. Email: gennuso@wisc.edu.
authors.forename: Keith P
authors.initials: KP
authors.lastname: Gennuso
authors.affiliation: University of Wisconsin Population Health Institute, University of Wisconsin, Madison, Wisconsin.
authors.forename: Amanda
authors.initials: A
authors.lastname: Jovaag
authors.affiliation: University of Wisconsin Population Health Institute, University of Wisconsin, Madison, Wisconsin.
authors.forename: Bridget B
authors.initials: BB
authors.lastname: Catlin
authors.affiliation: University of Wisconsin Population Health Institute, University of Wisconsin, Madison, Wisconsin.
authors.forename: Matthew
authors.initials: M
authors.lastname: Rodock
authors.affiliation: Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin.
authors.forename: Hyojun
authors.initials: H
authors.lastname: Park
mesh_terms: D000407:Alabama; D001131:Arkansas; D004777:Environment; D054624:Health Status Disparities; D006801:Humans; D007087:Illinois; D007230:Infant, Low Birth Weight; D007629:Kentucky; D008145:Louisiana; D008922:Mississippi; D008923:Missouri; D009026:Mortality; D057566:Self Report; D012959:Socioeconomic Factors; D013714:Tennessee