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Degree Name

DrPH (Doctor of Public Health)


Public Health

Date of Award


Committee Chair or Co-Chairs

Timothy E. Alich

Committee Members

Amal Khoury, James L. Anderson, Patricia Vanhook


As the US population ages, public health agencies must examine better ways to measure the impact of adverse health outcome on a population. Many reports have asserted that more adverse health events occur in Appalachia. However, few studies have assessed the quality of life and burden of disease on those residing in Appalachia. Therefore, the overall aim of this dissertation was to assess the health status, burden of disease, and quality of life in Appalachia using available data and improved health outcome assessment measures.

For this dissertation, 3 secondary data sources collected by the State of Tennessee and the National Center for Health Statistics (NCHS) were used. These data were used to calculate the index of disparity and absolute and relative disparity measures within the study area of 8 Appalachian counties in upper east Tennessee. Vital statistics data for the selected area were also used to calculate Disability Adjusted Life Years (DALYs) by gender for all cause mortality and stroke mortality. The Behavior Risk Factor Surveillance System (BRFSS) data were used for prevalence data and to determine what factors impact Health Related Quality of Life (HRQOL) within the study area.

The Index of disparity (ID) for all cause mortality for the study area found that disparity is greatest in stroke mortality for the study area and TN and the least for all cause mortality and the US. The highest numbers of DALYs was found in the 45-59 age group for the Appalachian study population. Finally, the mean general health status did not vary significantly by gender; however, predictors of reporting excellent to good health status did vary based on gender. Predictors of fair to poor general health status were found to be low income, having diabetes, or having had a stroke or heart attack.

The results within this dissertation are intended to assist health professionals with the creation of health interventions and policy development within the Appalachian area. This dissertation proposes a more comprehensive health status monitoring system for assessing health disparity at a regional level.

Document Type

Dissertation - restricted


Copyright by the authors.