Appalachian Numeracy and Literacy and Oral Health, an Ecological Study, PIAAC and BRFSS

Social determinants of health (SDOH) include healthcare access, neighborhood/built environment, social context, economic stability, and education (including literacy and numeracy). These are known factors for health outcomes. The purpose of this research is to consider one SDOH category: general literacy/numeracy levels, with poor oral health indicators in a comparison of U.S. national and Appalachia data, a region with many poor healthcare indicators.

For this ecological study, literacy/numeracy data were from the Programme for the International Assessment of Adult Competencies (PIAAC) Survey of Adult Skills, 2012-2017. Oral health indicators were from the Behavioral Risk Factor Surveillance System, 2012-2016.

Of a possible score of 500 for literacy/numeracy, the mean national scores were 263.5(95% CI: 262.0, 265.1) and 249.1 (95% CI: 247.5, 250.6), respectively. The mean scores for all Appalachian counties were similar (262.2; 95% CI: 261.3, 263.1; p = 0.7258) and (247.6; 95% CI: 246.6, 248.6; p = 0.6872), respectively. However, within state comparisons had several non-Appalachian counties with higher literacy/numeracy scores than their Appalachian counties (Kentucky, Ohio, and Virginia) while in Alabama, the reverse occurred. Overall, state-wide, dental visits were not significantly different from national levels in crude percentages; however, missing any permanent teeth and edentulism were higher than the nation.

Health concerns, and oral health concerns in particular, are significant for the Appalachian region. However, dental visits and the mean overall general literacy/numeracy skills were not significantly different from the nation's, indicating that other factors are driving poor health outcomes within Appalachia from an ecological perspective.