Research Finds That Appalachia’s Diseases of Despair Mortality Rates Continue at Disproportionately Higher Rates in Comparison to Rest of Nation

For Women, Disease of Despair Mortality Rates  in Appalachia  Over 45 Percent Higher Than Rest of Country 

Washington, D.C., November, 19, 2020 —  Appalachian Diseases of Despair, a new report from the Appalachian Regional Commission finds that despite overall declining mortality rates from diseases of despair (overdose, suicide, and liver disease) between 2017-2018, the Region’s diseases of despair mortality rate in 2018 was still 36 percent higher than the rate for the non-Appalachian United States. Moreover, among Appalachians in the prime working ages of 25–54, the diseases of despair mortality rate was 43 percent higher in the Region than the rest of the country. The report also found that for men ages 15-64, the diseases of despair mortality rate was 31 percent higher in the Appalachian Region than in the rest of the country; for women, however, the disparity was even larger, with the rate 46 percent higher in the Region than in the non-Appalachian United States.  

 “While  trends revealed by this report may seem positive, the Appalachian Region still needs support,” said ARC Federal Co-Chairman Tim Thomas. “Researchers and  policy makers rely on this important data to explore solutions to the issues we face. This report highlights why ARC’s economic development efforts are so critical when it comes to addressing issues like substance abuse.” 

Additionally, the report, which was released today as part of National Rural Health Day, found that in 2018: 

  • West Virginia and Appalachian Maryland had the highest diseases of despair mortality rates among all Appalachian states, while the Appalachian portions of Mississippi, Georgia, and New York had the lowest. In Appalachian Maryland, West Virginia, Appalachian Ohio, and Appalachian Pennsylvania, at least 60 percent of diseases of despair deaths were due to overdose. 
  • The states with the highest percentages of overdose deaths attributed to opioids within their Appalachian portions were Maryland (92 percent); West Virginia (83 percent); North Carolina (81 percent); Ohio (78 percent); and Virginia (76 percent). The states with the lowest percentage of overdose deaths attributed to opioids were Appalachian Mississippi (45 percent) and Appalachian Alabama (54 percent). 
  • While the rate of overdose deaths was greater in metro counties in Appalachia, the rates of suicide and  liver disease  were higher in nonmetro counties. 

Anticipating the impact the COVID crisis and other events may have on future findings, the report notes that “Anecdotal evidence has suggested dramatic increases in overdose deaths in many regions during the COVID-19 pandemic. The impact of COVID-19 will likely lead to an increase in mortality from diseases of despair, particularly as the Appalachian Region and the rest of the United States experience economic challenges as a result of the pandemic, isolation, and limitations on access to in-person treatment and recovery support. It will be important to continue to monitor these trends in diseases of despair mortality in the Appalachian Region.” 

Appalachian Diseases of Despair research was conducted by The Walsh Center for Rural Health Analysis at NORC at the University of Chicago, and the Center for Rural Health Research at East Tennessee State University, and draws on 2018 mortality data from the Centers for Disease Control and Prevention. The report is a follow up to similar research  released in 2017 when the United States was seeing a dramatic rise in overdose deaths from synthetic opioids, particularly those involving illicitly manufactured fentanyl.   

In 2019, ARC established the Substance Abuse Advisory Council (SAAC)  to address the disproportionate impact substance abuse continues to have on the Region’s workforce in comparison to the rest of the country. Earlier this year, ARC launched the INvestments Supporting Partnerships In Recovery Ecosystems (INSPIRE) Initiative, a $10 million initiative addressing the substance abuse crisis by creating or expanding a recovery ecosystem that will lead to workforce entry or re-entry. ARC received more than  60 applications in response to INSPIRE’s inaugural request for proposals. Grant announcement are expected in early 2021. 

About the Appalachian Regional Commission  

The Appalachian Regional Commission ( is an economic development agency of the federal government and 13 state governments focusing on 420 counties across the Appalachian Region. ARC’s mission is to innovate, partner, and invest to build community capacity and strengthen economic growth in Appalachia to help the Region achieve socioeconomic parity with the nation.