Telehealth-Readiness, Healthcare Access, and Cardiovascular Health in the Deep South: A Spatial Perspective

Ruaa Al Juboori (), Dylan Barker, Andrew Yockey, Elizabeth Swindell, Riley Morgan and Neva Agarwala
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Ruaa Al Juboori: Department of Public Health, School of Applied Sciences, The University of Mississippi, University, MS 38677, USA
Dylan Barker: Department of Public Health, School of Applied Sciences, The University of Mississippi, University, MS 38677, USA
Andrew Yockey: Department of Public Health, School of Applied Sciences, The University of Mississippi, University, MS 38677, USA
Elizabeth Swindell: Department of Public Health, School of Applied Sciences, The University of Mississippi, University, MS 38677, USA
Riley Morgan: Department of Public Health, School of Applied Sciences, The University of Mississippi, University, MS 38677, USA
Neva Agarwala: Department of Health Science, South College, 2600 Century Parkway NE, Atlanta, GA 30345, USA

IJERPH, 2025, vol. 22, issue 7, 1-24

Abstract: Background: Cardiovascular disease remains a leading cause of preventable mortality in the United States, with rural counties in the Deep South experiencing disproportionately high burdens. Grounded in the Andersen healthcare utilization model, this study examined how enabling resources, predisposing characteristics, and access-related barriers relate to coronary heart disease (CHD) prevalence and mortality. Methods: This ecological analysis included 418 counties across Alabama, Georgia, Louisiana, Mississippi, and South Carolina. Using Local Indicators of Spatial Association (LISA) and multivariable linear regression, we tested three theory-based hypotheses and assessed the spatial clustering of CHD outcomes, while identifying key structural and sociodemographic predictors. Results: Counties with greater rurality and fewer healthcare providers exhibited significantly higher rates of CHD prevalence and mortality. Primary care provider availability and higher household income were protective factors. Digital exclusion, measured by lack of access to computers or mobile devices, was significantly associated with higher CHD prevalence and mortality. Spatial analysis identified the counties with better-than-expected cardiovascular outcomes despite structural disadvantages, suggesting the potential role of localized resilience factors and unmeasured community-level interventions. Conclusions: The findings affirm the relevance of the Andersen model for understanding rural health disparities and highlight the importance of investing in both digital infrastructure and healthcare capacity. Expanding telehealth without addressing provider shortages and social determinants may be insufficient. Local policy innovations and community resilience mechanisms may offer scalable models for improving cardiovascular health in disadvantaged areas.

Keywords: cardiovascular disease; telehealth readiness; spatial analysis; healthcare provider shortages; broadband access; Deep South; Moran’s I (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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