Spatial Relationships among Cardiovascular Disease Mortality for Women, Medical Resource Distribution, and Prevalence of Risk Factors in Appalachian Pennsylvania

The largest city in Appalachia, Pittsburgh is in the largely rural area of southwestern Pennsylvania (PA); forty-eight of the 52 Appalachian PA counties have a rural designation, yet resources primarily exist in the urban cores of the area. Across the Appalachian region, premature mortality rates are 25 percent higher than all US counties, and Appalachians have significantly higher rates of heart disease mortality than national averages, including high rates for women. This study explores how medical resource distribution (e.g., density of hospitals, rural health clinics, FQHCs) and known contextual risk factors (e.g., food environment, physical activity environment) relate to cardiovascular disease (CVD) mortality for women in the 52 Appalachian PA counties. Using QGIS and GeoDa, we conducted Exploratory Spatial Data Analysis (ESDA) to display: 1) CVD mortality rates among women; 2) medical resource density; and 3) prevalence of contextual risk factors. We then assessed global and local spatial autocorrelation and conducted regression and spatial lag models to assess the relationship between these variables. These findings establish evidence for additional spatial exploration of the role of resources and contextual risk factors for CVD health outcomes among women in Appalachia and show localized clusters to implement context-specific interventions or prevention efforts. In concert with local community groups and agencies, the results from this study will be used to identify communities for further exploration of these relationships and to assess how the distribution of resources in the environment directly impacts the health of women in the Appalachian region.