FRANKFORT, Ky. (AP) — The 25 million people who live among the Appalachian mountains have struggled to keep up with health gains of the rest of the nation, falling behind in most major public health indicators, according to a study released Thursday. The report shows the 13-state region lags the rest of the country in 33 out of 41 population health indicators, including seven of the leading 10 causes of death in the United States.