Mapping Health-Related Quality of Life in Mississippi: Longitudinal Spatial Clustering and Socioeconomic Drivers

Abstract Background Mississippi consistently ranks among the lowest U.S. states in health-related quality of life (HRQoL) outcomes, with disparities most severe in rural and socioeconomically disadvantaged counties, particularly the Mississippi Delta. Understanding longitudinal spatial and temporal patterns is essential for equity-focused public health strategies and chronic disease prevention. Objective This study examined geographic disparities in HRQoL across Mississippi’s 82 counties from 2015 to 2025 to identify persistent hotspots, assess convergence with national averages, and inform targeted interventions. Methods County-level data from the County Health Rankings & Roadmaps (2015–2025 releases) were used to construct an annual principal component analysis–derived composite HRQoL score from Behavioral Risk Factor Surveillance System measures (percentage reporting poor or fair health, physically unhealthy days, and mentally unhealthy days). Spatial patterns were assessed using choropleth maps, Moran’s I, and Local Indicators of Spatial Association (LISA). A spatial autoregressive lag model with year fixed effects identified key drivers. Results Mississippi showed persistent disadvantage in poor or fair health (stable gap of 0.06–0.07 percentage points above national averages) but recent convergence in physically unhealthy days and reversal in mentally unhealthy days (fewer days in disadvantaged subgroups, e.g., high child poverty and low education). LISA maps revealed enduring High-High hotspots of poor HRQoL in the Delta region, while Low-Low cold spots along the Gulf Coast contracted substantially by 2025 (many formerly advantaged counties now non-significant). The spatial lag model confirmed significant dependence (ρ = 0.13, P < .001), with adult smoking and uninsurance as leading modifiable predictors. Conclusions Mississippi’s HRQoL trajectory shows symptom-based improvements alongside enduring structural disparities in self-rated health and persistent geographic inequities. Expanding smoke-free policies (particularly in the Delta), strengthening primary care access, and increasing insurance coverage represent high-impact strategies to reduce disparities, advance health equity, and support chronic disease prevention in high-burden regions of the U.S. South.