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. 2024 Jan;40(1):87-95.
doi: 10.1111/jrh.12763. Epub 2023 Apr 24.

Cancer disparities in Appalachian Kentucky

Lauren Hudson  1 , Todd Burus  2 , Lee Park  3 , Bin Huang  2   4   5 , Pamela C Hull  2   6 , Nathan L Vanderford  2   7
Affiliations

Cancer disparities in Appalachian Kentucky

Lauren Hudson et al. J Rural Health. 2024 Jan.

Abstract

Purpose: Cancer is the second leading cause of death in the United States, and the disease burden is elevated in Appalachian Kentucky, due in part to health behaviors and inequities in social determinants of health. This study's goal was to evaluate Appalachian Kentucky's cancer burden compared to non-Appalachian Kentucky, and Kentucky compared to the United States (excluding Kentucky).

Methods: The following data were analyzed: annual all-cause and all-site cancer mortality rates from 1968 to 2018; 5-year all-site and site-specific cancer incidence and mortality rates from 2014 to 2018; aggregated screening and risk factor data from 2016 to 2018 for the United States (excluding Kentucky), Kentucky, non-Appalachian Kentucky, and Appalachian Kentucky; and human papilloma virus vaccination prevalence by sex from 2018 for the United States and Kentucky.

Findings: Since 1968, the United States has experienced a large decrease in all-cause and cancer mortality, but the reduction in Kentucky has been smaller and slower, driven by even smaller and slower reductions within Appalachian Kentucky. Appalachian Kentucky has higher overall cancer incidence and mortality rates and higher rates for several site-specific cancers compared to non-Appalachian Kentucky. Contributing factors include screening rate disparities and increased rates of obesity and smoking.

Conclusions: Appalachian Kentucky has experienced persistent cancer disparities, including elevated all-cause and cancer mortality rates for 50+ years, widening the gap between this region and the rest of the country. In addition to addressing social determinants of health, increased efforts aimed at improving health behaviors and increased access to health care resources could help reduce this disparity.

Keywords: Appalachian Kentucky; cancer disparity; cancer incidence; cancer mortality; health behaviors.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Age-adjusted all-cause mortality rates (deaths per 100,000 people) in the United States (excluding Kentucky), Kentucky, non-Appalachian Kentucky, and Appalachian Kentucky from 1968 to 2018.
FIGURE 2
FIGURE 2
Age-adjusted cancer mortality rates (deaths per 100,000 population) in the United States (excluding Kentucky), Kentucky, non-Appalachian Kentucky, and Appalachian Kentucky from 1968 to 2018.
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References

    1. American Cancer Society. Cancer Facts & Figures, 2022. Atlanta, GA: American Cancer Society; 2022.
    1. Centers for Disease Control and Prevention. Stats of the State of Kentucky. Accessed January 11, 2023. Available at: https://www.cdc.gov/nchs/pressroom/states/kentucky/kentucky.htm. 2023.
    1. Appalachian Regional Commission. About the Appalachian Region. Appalachian Regional Commission. Accessed January 11, 2023. Available at: https://www.arc.gov/about-the-appalachian-region/
    1. Appalachian Regional Commission. Rural Appalachia Compared to the Rest of Rural America. Accessed January 11, 2023. Available at: https://www.arc.gov/rural-appalachia/. 2023.
    1. National Cancer Institute: GIS Portal for Cancer Research. Rural-Urban Disparities in Cancer. 2022.

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