Cancer in Appalachia, 2001–2003

Abstract

METHODS. Forty-four states and the District of Columbia provided informationfor the diagnosis years 2001 through 2003 from cancer registries that met highquality data criteria. Eleven of 13 states with counties in Appalachia, covering 88% of the Appalachian population, met these criteria; Virginia and Mississippi were included for 2003 only. SEER*Stat was used to calculate age-adjusted rates per 100,000 population and 95% gamma confidence limits. RESULTS.Overall, cancer incidence rates were higher in Appalachia than in the rest of the US; the rates for lung, colon/rectum, and other tobacco-related cancers were particularly high. Central Appalachia had the highest rates of lung (men: 143.8; women: 75.2) and cervical cancer (11.2)-higher than the other 2 regions and the rest of the US. Northern Appalachia had the highest rates for prostate, female breast, and selected other sites, and Southern Appalachia had the lowest overall cancer incidence rates.CONCLUSIONS. Cancer incidence rates in Appalachia are higher than in the rest of the US, and they vary substantially between regions. Additional studies are needed to understand how these variations within Appalachia are associated with lifestyle, socioeconomic factors, urban/rural residence, and access to care.

Distribution of Cardiovascular Disease and Associated Risk Factors by County Type and Health Insurance Status: Results from the 2008 Ohio Family Health Survey

“…These findings reinforce the results of other studies: Appalachian residents often characterized by lower income and limited education are at an increased risk for health problems. 19,20 Our results contribute to the literature by suggesting that, even with similar public health coverage, Medicaid enrollees in rural and Appalachian counties are more likely to report poorer health outcomes, specifically as related to hypertension, diabetes, and cardiovascular disease, than Medicaid enrollees in other regions. Medicaid enrollees in Appalachian and rural counties may experience more barriers to care due to fewer primary care providers and geographic isolation, causing them to have to travel long distances for care.…”

Variability of cervical cancer rates across 5 Appalachian states, 1998-2003

“…This pattern is also consistent with the notion that although Appalachia as a whole is often regarded as a disadvantaged region with respect to economic and social factors as well as health risks, 5,24,25 it encompasses a large and heterogeneous area of the country. This has been documented particularly for cancer, as reflected by the variations in cancer incidence rates noted across Appalachia, 26 including marked differences in the rates of ICC. 7 This was also evident in the current analysis, with distinct patterns of risk observed across the northern, central, and southern regions of Appalachia, as described also in the study by Wingo et al 26 The higher rates of poverty and lower levels of education, in turn, reflect other underlying factors that contribute to the increased risk of ICC.…”

“…This has been documented particularly for cancer, as reflected by the variations in cancer incidence rates noted across Appalachia, 26 including marked differences in the rates of ICC. 7 This was also evident in the current analysis, with distinct patterns of risk observed across the northern, central, and southern regions of Appalachia, as described also in the study by Wingo et al 26 The higher rates of poverty and lower levels of education, in turn, reflect other underlying factors that contribute to the increased risk of ICC. In addition to the well-established necessary role of HPV infection in the development of ICC, smoking has been clearly identified as a contributory factor, conferring approximately double the risk of ICC among women who smoke.…”

Racial and regional disparities in lung cancer incidence

“…Variation in US lung cancer incidence by geographic region has been reported in 38 states, 36 as well as within AI/AN and Appalachian subpopulations. 11,37 Here, we present the first comprehensive analysis of lung cancer incidence covering the entire US population. Our findings will help public health practitioners by identifying racial, ethnic, and geographic subgroups that have disproportionately high lung cancer incidence and may particularly benefit from implementation of evidencebased tobacco prevention and cessation efforts.…”