Gestational Diabetes, Subsequent Type 2 Diabetes, and Food Security Status: National Health and Nutrition Examination Survey, 2007-2018.

INTRODUCTION

Mississippi ranks among the lowest US states in health-related quality of life (HRQoL), with disparities most severe in rural and socioeconomically disadvantaged counties, particularly the Mississippi Delta. Understanding long-term spatial and temporal patterns is critical for equity-focused public health strategies. We aimed to describe geographic disparities in HRQoL across Mississippi's 82 counties from 2015 through 2025, identify persistent hot spots of poor health, assess convergence with national averages, and inform tailored interventions.

METHODS

We used County Health Rankings & Roadmaps data (2015-2025) to construct an annual principal component analysis-derived composite HRQoL index from Behavioral Risk Factor Surveillance System measures (poor/fair health, physically unhealthy days, mentally unhealthy days). Local indicators of spatial association (LISA), emerging hot spot analysis (EHSA), and a spatial autoregressive lag model with year fixed effects assessed clustering, spatiotemporal trends, and predictors.

RESULTS

We found persistent disadvantage in poor/fair health in Mississippi (stable gap of 6 to 7 percentage points above national averages) but recent convergence in physically unhealthy days and reversal in mentally unhealthy days (fewer days in disadvantaged subgroups). LISA identified a persistent hot spot in the Delta and contraction of cold spots along the Gulf Coast by 2025. EHSA showed sporadic and consecutive hot spots concentrated in the Delta. The spatial autoregressive lag model confirmed significant dependence (ρ = 0.13, P < .001), with adult smoking and uninsurance as leading modifiable predictors.

CONCLUSION

Mississippi's HRQoL trajectory shows symptom-based improvements but persistent structural inequities and geographic disparities. Expanding smoke-free policies, strengthening primary care access, and increasing health insurance coverage are high-impact strategies to reduce disparities and advance health equity in the South.