Role of Medical Insurance in Reducing Place‐based Health Disparities: Functional Disability in Rural Appalachia

Abstract

AbstractRural Appalachia, including the entire state of West Virginia, is characterized by high health disparities. Such place‐based health disparities contribute to disability across the lifespan and may exacerbate morbidity and disability in late life. Thus, examinations of the contributors to morbidity and disability at mid‐and late‐life are needed to inform policies and programs.Using the most recent data from the Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS), we examine some of the social determinants of health (e.g., age, gender, education, income) as predictors of access to health care and functional ability among 4,867 adults living in West Virginia. Access to health care was indexed by three variables, including whether one had financial barriers to medical care, the number of personal medical care professionals one saw, and the recency of wellness exams. Functional ability was indexed using items assessing difficulty with dressing, climbing stairs, and doing errands. The model fit the data well for the entire sample, X2 (DF = 29, N = 4867) = 411.30, p < .001, CFI = .94, RMSEA = .052. Post hoc models with the age groups fit well, although some differences in specific paths emerged. Our results suggest that policies and programs that increase medical access for current middle‐aged and older adults might decrease functional ability. Moreover, as the younger adults age into midlife, they enter with lower economic and educational resources, further exacerbating their lack of access to health care and increasing disability in future generations of West Virginians.