Appalachian and Urban Children Face Similar Health Care Challenges

Appalachian and Urban Children Face Similar Health Care Challenges 150 150 Katelyn Hanzel

Research shows children in Ohio’s Appalachian counties face similar health care challenges to those in metropolitan areas

Despite the fact that previous research shows the Appalachian region of the United States as limited in access to health care services, researchers at Nationwide Children’s Hospital have found that children with special health care needs in Appalachian areas of Ohio face similar levels of health status as their metropolitan Ohio counterparts.

Researchers used data from the 2012 Ohio Medicaid Assessment Survey, which is designed to examine the health status and health insurance needs of Ohio adults and children. This study, published in the Journal of Health Care for the Poor and Underserved, is one of the first of its kind to use a population-based survey to assess the health status of children with special health care needs (identified by The Federal Maternal and Child Health Bureau as CSHCN) in Appalachian Ohio. Results showed that children with special needs living in Appalachian Ohio counties are poorer and more likely to be insured by Medicaid than their metropolitan counterparts but otherwise face the same health care challenges as those in urban areas.

“One marked difference is that children with special needs in Appalachia are more likely to frequent emergency departments and less likely to have access to primary care,” said Deena Chisolm, PhD, program director of the Patient-Centered Pediatric Research Program in The Research Institute at Nationwide Children’s and co-author of the study. “This trend raises concerns about access to appropriate levels of service that should be explored in future research.”

The Ohio Medicaid Assessment Survey assessed approximately 23,000 Ohio residents between May 2012 and August 2012 with an overall response rate of 29.4 percent. Households with children were purposefully oversampled. A child met the definition of CSHCN if the survey respondent reported that the child used prescription medication, used more health or educational services than other children, was limited in their ability to do things most similarly-aged children could do, received special therapy or received emotional or behavioral counseling and that the condition or services use was expected to last for greater than 12 months.

“Primary care is important for all children, and crucial for children with special needs,” said Dr. Chisolm. “Further research is necessary in order to better understand how to best serve children with special health care needs who live in very rural areas and Appalachia.”


Earley E, Asti L, Chisolm D. Comparative analysis of health care needs among children with special health care needs in Ohio’s metropolitan and Appalachian countiesJournal of Health Care for the Poor and Underserved. 2015 Aug;26(3):668-675.


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