Cancer Mortality Rates in Appalachia: Descriptive Epidemiology and an Approach to Explaining Differences in Outcomes
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Cancer is a leading cause of death in the Appalachian region of the United States. Existing studies compare regional mortality rates to those of the entire nation. We compare cancer mortality rates in Appalachia to those of the nation, with additional comparisons of Appalachian and non-Appalachian counties within the 13 states that contain the Appalachian region. Lung/bronchus, colorectal, female breast and cervical cancers, as well as all cancers combined, are included in analysis. Linear regression is used to identify independent associations between ecological socioeconomic and demographic variables and county-level cancer mortality outcomes. There is a pattern of high cancer mortality rates in the 13 states containing Appalachia compared to the rest of the United States. Mortality rate differences exist between Appalachian and non-Appalachian counties within the 13 states, but these are not consistent. Lung cancer is a major problem in Appalachia; most Appalachian counties within the 13 states have significantly higher mortality rates than in-state, non-Appalachian counterparts. Mortality rates from all cancers combined also appear to be worse overall within Appalachia, but part of this disparity is likely driven by lung cancer. Education and income are generally associated with cancer mortality, but differences in the strength and direction of these associations exist depending on location and cancer type. Improving high school graduation rates in Appalachia could result in a meaningful long term reduction in lung cancer mortality. The relative importance of household income level to cancer outcomes may be greater outside the Appalachian regions within these states.
KeywordsAppalachia Cancer mortality Lung cancer Disparities
Funding for this project was provided by a grant through an Interagency Agreement between the Appalachian Regional Commission and the Centers for Disease Control and Prevention # CO—15409. The authors would like to thank Deborah Gregg, Rachel Ward and Jim Anderson for reviews and comments.
- 1.Appalachian Regional Commission. (2011). Appalachian Regional Commission History. http://www.arc.gov/about/ARCHistory.asp.
- 4.Behringer, B., & Friedell, G. H. (2006). Appalachia: Where place matters in health. Preventing Chronic Disease, 3(4), 1–4.Google Scholar
- 5.Dignan, M., Paskett, E., & Lengerich, E. (2010). Addressing the cancer burden in Appalachian communities. Appalachia Community Cancer Network. Google Scholar
- 6.Gregg, D. B. (2006). Cancer mortality disparities in Central Appalachia: Kentucky, Tennessee and Virginia counties. Rural Appalachian Cancer Demonstration Program. http://www.etsu.edu/kellogg/Documents/(12)%20Data%20Based%20Disparities%20article.pdf.
- 7.Halverson, J. A., Ma, L., & Harner, E.J. (2004). An analysis of disparities in health status and access to health care in the Appalachian region. Prepared for Appalachian Regional Commission. http://www.arc.gov/research/researchreportdetails.asp?REPORT_ID=82.
- 8.Lengerich, E. J., Wyatt, S.W., & Rubio, A. (2004). The Appalachian cancer network: Cancer control research among a rural, medically underserved population. Journal of Rural Health, Spring, 181–187.Google Scholar
- 9.Huang, B., Wyatt, S. W., Tucker, T. C., Bottorff, D., Lengerich, E., & Hall, H. I. (2002). Cancer death rates—Appalachia, 1994–1998. Morbidity and Mortality Weekly Report, 51(24), 527–529.Google Scholar
- 10.Yabroff, K. R., Lawrence, W. F., & King, J. C. (2005). Geographic disparities in cervical cancer mortality: What are the roles of risk factor prevalence, screening, and use of recommended treatment. Journal of Rural Health, Spring, 149–157.Google Scholar
- 12.Appalachian Regional Commission. Poverty Rates, 2005–2009. (2010). www.arc.gov/reports.
- 17.Robert Wood Johnson Foundation. (2009). Education and health, 1–15. www.commissiononhealth.org.
- 18.Appalachian Regional Commission. (2005). Education—high school and college completion rates, 2000. www.arc.gov/data.
- 28.Surveillance, Epidemiology, and End Results (SEER) Program. (2011). National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch. www.seer.cancer.gov.
- 29.Chenowith, E., & Galliher, R. V. (2004). Factors influencing college aspirations of rural West Virginia high school students. Journal of Research in Rural Education, 19(2), 1–14.Google Scholar
- 31.Pollard, K. M. (2004). A new diversity: Race and ethnicity in the Appalachian region. Series on demographic and socioeconomic change in Appalachia. Washington, DC: Population Reference Bureau and Appalachian Regional Commission.Google Scholar