Bottom Line: Men and women in Appalachia continue to have higher cancer incidence rates compared with those in the rest of the United States regardless of race or location. The disparity is attributed in part to high tobacco use, potential differences in socioeconomic status, and patient health care utilization.
Journal in Which the Study was Published: Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research
Author: Reda Wilson, MPH, an epidemiologist at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia
Background: "The Appalachian region, which extends from parts of New York to Mississippi, spans 420 counties in 13 U.S. states and about 25 million people reside in this area," said Wilson. "This region is primarily made up of rural areas with persistent poverty levels that are at least 20 percent, which is higher than the national average."
In 2007, the CDC's National Program of Cancer Registries (NPCR) published a comprehensive evaluation of cancer incidence rates in Appalachia between 2001 and 2003. Data showed higher incidence rates in Appalachia than in the rest of the United States, Wilson explained. However, this publication had some shortcomings, including data that were not available for analysis. "The current analyses reported here were performed to update the earlier evaluation by expanding the diagnosis years from 2004 to 2011, and including data on 100 percent of the Appalachian and non-Appalachian populations," Wilson said.
How the Study Was Conducted: To compare age-adjusted cancer incidence rates, Wilson and colleagues used data from the National Program of Cancer Registries (NPCR) and data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program that were used to generate the U.S. Cancer Statistics Web-based report. Together, NPCR and SEER cover 100 percent of the U.S. population.
Results: The researchers analyzed the data on the Appalachian population by dividing them into residents from three regions (counties in the north, central, and south Appalachia) and by gender, race (black and white), and by Appalachian Regional Commission-designated economic status (distressed, at-risk, transitional, competitive, and attainment), and compared them with data on the non-Appalachian population. They found that the cancer incidence rates were elevated among Appalachians regardless of how they were categorized.
Author Comment: "Appalachia continues to have higher cancer incidence rates than the rest of the country. But a promising finding is that we're seeing the gap narrow in the incidence rates between Appalachia and non-Appalachia since the 2007 analysis with the exception of cancers of the oral cavity and pharynx, larynx, lung and bronchus, and thyroid," Wilson said.
"This study helps identify types of cancer in the Appalachian region that could be reduced through more evidence-based screening and detection," she added. "Our study also emphasizes the importance of lifestyle changes needed to prevent and reduce cancer burden."
Study Limitations: The study did not differentiate urban versus rural areas within each county, and the data on screening and risk factors were based on self-reported responses. Further, cancer incidence rates were calculated for all ages combined and were not evaluated by age groups. Future analyses will be targeted toward capturing these finer details, Wilson noted.
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Funding & Disclosures: This study was funded by CDC. Wilson declares no conflicts of interest.
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