Cancer Incidence in Appalachia, 2004-2011

Abstract

Background: Limited literature is available about cancer in the Appalachian Region. This is the only known analysis of all cancers for Appalachia and non-Appalachia covering 100% of the US population. Appalachian cancer incidence and trends were evaluated by state, sex, and race and compared with those found in non-Appalachian regions.

Methods: US counties were identified as Appalachian or non-Appalachian. Age-adjusted cancer incidence rates, standard errors, and confidence intervals were calculated using the most recent data from the United States Cancer Statistics for 2004 to 2011.

Results: Generally, Appalachia carries a higher cancer burden compared with non-Appalachia, particularly for tobacco-related cancers. For all cancer sites combined, Appalachia has higher rates regardless of sex, race, or region. The Appalachia and non-Appalachia cancer incidence gap has narrowed, with the exception of oral cavity and pharynx, larynx, lung and bronchus, and thyroid cancers.

Conclusions: Higher cancer incidence continues in Appalachia and appears at least in part to reflect high tobacco use and potential differences in socioeconomic status, other risk factors, patient health care utilization, or provider practices. It is important to continue to evaluate this population to monitor results from screening and early detection programs, understand behavioral risk factors related to cancer incidence, increase efforts to reduce tobacco use and increase cancer screening, and identify other areas where effective interventions may mediate disparities.

Impact: Surveillance and evaluation of special populations provide means to monitor screening and early detection programs, understand behavioral risk factors, and increase efforts to reduce tobacco use to mediate disparities.

Figure 1.

County Economic Status in Appalachia, 2010–2011. Map by the ARC produced in March 2010, reproduced in August 2015 by the Centers for Disease Control and Prevention with permission. Sources, the U.S. Bureau of Labor Statistics, LAUS, 2006–2008; U.S. Bureau of Economic Analysis, REIS, 2007; and U.S. Census Bureau, 2000 Census, SF3.

Figure 2.

Temporal trends in invasive cancer IRs by cancer site, sex, and Appalachian status, United States, 2001–2011. Rates are per 100,000 and age-adjusted to the 2000 US standard population. Percent change (PC) was used to quantify the total percent change in rates from 2001 to 2011. Annual percent change (APC) was used to quantify the change in rates during 2001 to 2011 and was calculated using weighted least squares regression. Caret (^) denotes APC is significantly different from zero (P < 0.05). Appalachia includes select counties in Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia, and all counties in West Virginia. Non-Appalachia includes all counties not in Appalachia.