Abstract
BACKGROUND: Limited research has explored the application of community health needs assessments in rural communities. This paper investigates a model approach used by WNC Healthy Impact, a regional collaboration between local health departments and hospital systems. Our study examines health inequalities in rural Southern Appalachia through the lens of selected social determinants of health (SDoH), with a particular focus on race, ethnicity, and poverty. METHODS: We combined cross-sectional data from 5 waves (2012-2024) of a population-based community health needs assessment (CHNA) survey, analyzing complex survey data from 18 counties in Southern Appalachia. Multivariate logistic regression was used to examine associations between self-reported health outcomes and key SDoH. RESULTS: Lowest-income residents had significantly higher odds of chronic obstructive pulmonary disease (COPD), poor mental health, cardiovascular disease (CVD), asthma, diabetes, and obesity. Compared to high-income earners, the lowest-income group had twice the odds of diabetes, COPD, and CVD, and more than three times the odds of poor mental health. Black residents had 84% higher odds of high blood pressure and 44% higher odds of diabetes than White residents. American Indian/Alaska Native residents, regardless of income level, had significantly higher odds of asthma, diabetes, and obesity. LIMITATIONS: Small racial/ethnic subgroup sizes limited certain analyses, and the cross-sectional design prevented assessment of longitudinal trends. CONCLUSIONS: Findings highlight the enduring impact of income and racial disparities on health in a predominantly rural region. Addressing these disparities is essential for developing community health improvement plans that target the root causes of health disparities, ultimately fostering improved health outcomes across diverse rural communities.