This study compares the health status of Appalachian children living in Cincinnati neighborhoods to that of children living in five predominantly low-income black neighborhoods and children living in the rest of Cincinnati. Age-specific, standardized morbidity ratio analyses were performed to compare the frequency of admissions to hospital and discharge diagnoses of the three groups of children between July 1, 1985 and June 30, 1990. Black and Appalachian groups were identified based on zip codes designated as having residential concentrations of these groups. Little difference was found in hospital admission rates across the three groups. However, contrasting children 0 to 4 years old living in the Appalachian zip codes with children of the same age from the city of Cincinnati as a whole, Appalachian children were discharged more frequently from the hospital with diseases classified as viral or bacterial infections of the gastrointestinal, nervous, and respiratory systems, diseases of the genito-urinary system, injuries, and poisonings. Among the children 5 to 11 years of age, the Appalachian children were discharged more frequently with bacterial infections, diseases of the ear, digestive system, genito-urinary system, and injuries. The study concludes that children living in predominantly Appalachian zip codes have distinctive health care needs that differ from those of children living in predominantly black zip codes and in the city at large. Related public health questions include primary care facilities and preventative care. This document contains data tables and 24 references.