year,appalachian_rate,non_appalachian_rate,gap_pct,source
1999,35,28,25,ARC/NORC 2017 report; CDC WONDER NVSS; ages 15-64 age-adjusted
2002,38,30,27,ARC/NORC series; approximate from Exhibit 3 trendlines
2005,44,33,33,ARC/NORC series; approximate from Exhibit 3 trendlines
2008,50,37,35,ARC/NORC series; approximate from Exhibit 3 trendlines
2011,55,40,38,ARC/NORC series; approximate from Exhibit 3 trendlines
2014,72,50,44,ARC/NORC series; approximate from Exhibit 3 trendlines
2015,82,56,45,ARC/NORC 2017 report: rate 45% higher in Appalachia
2017,82,57,44,ARC/NORC 2020 update; peak year before brief decline
2018,76.1,56.2,35,ARC/NORC 2020 update: Meit et al. JAMA Network published
2019,76.7,57.7,33,ARC/NORC 2022 report: pre-pandemic baseline
2020,94.8,69.1,37,ARC/NORC 2022 report: COVID surge
2021,109.0,76.0,43,ARC/NORC 2023 report: pandemic peak
2022,105.0,76.4,37,ARC/NORC 2024 report
2023,100.0,73.0,37,ARC/NORC 2025 report: still 30%+ above 2019 in both regions