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Inflammatory Bowel Disease in Appalachian Kentucky: An Investigation of Outcomes and Health Care Utilization
Open accessAbstract
Background: Rural residence has been associated with a lower incidence of inflammatory bowel disease (IBD) but higher health care utilization and worse outcomes. Socioeconomic status is intrinsically tied to both IBD incidence and outcomes. Inflammatory bowel disease outcomes have not been investigated in Appalachia: a rural, economically distressed region rife with risk factors for both increased incidence and unfavorable outcomes. Methods: Hospital inpatient discharge and outpatient services databases were utilized to assess outcomes in patients diagnosed with either Crohn’s disease (CD) or ulcerative colitis (UC) in Kentucky. Encounters were classified by patient residence in Appalachian or non-Appalachian counties. Data were reported as crude and age-adjusted rates of visits per 100,000 population per year collected in 2016 to 2019. National inpatient discharge data from 2019, stratified by rural and urban classification codes, were utilized to compare Kentucky to national trends. Results: Crude and age-adjusted rates of inpatient, emergency department and outpatient encounters were higher in the Appalachian cohort for all 4 years observed. Appalachian inpatient encounters are more frequently associated with a surgical procedure (Appalachian, 676, 24.7% vs non-Appalachian, 1408, 22.2%; P = .0091). In 2019, the Kentucky Appalachian cohort had significantly higher crude and age-adjusted rates of inpatient discharges for all IBD diagnoses compared with national rural and nonrural populations (crude 55.2; 95% CI, 50.9-59.5; age-adjusted 56.7; 95% CI, 52.1-61.3). Conclusions: There is disproportionately higher IBD health care utilization in Appalachian Kentucky compared with all cohorts, including the national rural population. There is a need for aggressive investigation into root causes of these disparate outcomes and identification of barriers to appropriate IBD care.
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Kentucky displayed the highest AAMR, which can be explained by the low-resourced Appalachian counties that are dense in vulnerable populations at the risk of intestinal pathologies.
“States such as Kentucky displayed the highest AAMR, which can be explained by the low‐resourced Appalachian counties that are dense in vulnerable populations at the risk of intestinal pathologies [22].”
From Trends and Demographics of Vascular Intestinal Diseases‐Related Mortality Among Adults Living in United States From 1999 to 2020; A CDC Wonder Analysis (2025) · cites this paper as [22]
The Introduction (page unavailable) describes most Appalachian Kentucky counties as economically distressed and their residents as facing risks for inflammatory bowel disease and poorer outcomes. The Health Care Utilization Rate Analysis (page unavailable) reports higher age-adjusted rates of IBD-related visits and admissions, not mortality. It does not establish that Kentucky had the highest age-adjusted mortality rate (AAMR) or that conditions in Appalachian counties explain such a rate. (LLM, conf=0.88)
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Disparities in Chronic Pancreatitis Care in Appalachian Kentucky
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Metadata
- Authors
- Rhudy, C. N., Perry, C. L., Hawk, G. S., Flomenhoft, D. R., Talbert, J. C., & Barrett, T. A.
- Affiliations
- University of Kentucky HealthCare (US)
- University of Kentucky (US)
- ORCID
- Venue
- Inflammatory Bowel Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2023-06-06
- Volume
- 30
- Issue
- 3
- Pages
- 410-422
- ISSN
- 1078-0998 (ISSN-L)
- 1536-4844
- PMC
- PMC10906357
- OpenAlex
- W4379600734
- Cited by
- 2
- References
- 30
- Citations by year
- 2025: 2
- FWCI
- 0.33
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Inflammatory Bowel Diseases (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Advancing Translational Sciences (UL1TR001998)
- National Institutes of Health (TL1TR001997)
- National Institute of Diabetes and Digestive and Kidney Diseases (2RO1 DK095662-10A1, R21DK118954)
- Topics
- Health Sciences › Medicine › Gastroenterology › Inflammatory Bowel Disease
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Surgery › Diverticular Disease and Complications
- Keywords
- inflammatory bowel disease, Crohn's disease
- MeSH terms
- Child, Preschool, Colitis, Ulcerative, Crohn Disease, Humans, Kentucky, Patient Acceptance of Health Care, Inflammatory Bowel Diseases
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