New research reveals that while cancer incidence and death rates are declining in Appalachia, disparities persist compared to other parts of the U.S., particularly in Central Appalachia. The study, published in the Journal of the American College of Surgeons, analyzed county-level data from 2017-2021 and found that factors such as limited access to care, historical occupational risks, and socioeconomic factors contribute to the disparities. However, the researchers also highlight promising trends, including increased lung cancer screening rates in Kentucky, demonstrating the impact of targeted interventions.
Fewer people than before are being diagnosed with and dying from cancer in Appalachia, but cancer incidence and death rates remain substantially higher, especially in certain areas of Central Appalachia, compared to elsewhere in the U.S. The findings, published in the Journal of the American College of Surgeons (JACS), reflect the most up-to-date cancer data from the Appalachian region and include in-depth analyses within Appalachia by county.
The Appalachian region, which consists of 423 counties spanning 13 states along the eastern seaboard from Mississippi to southern New York, includes a population of more than 26 million. Abundant in rich folk culture and natural scenery, the region unfortunately also has faced considerable disparities in cancer rates in recent decades. But past research has not focused on granular data at the county level, the authors said. The Appalachian region is so large, so to view it as monolithic I think is shortsighted. The experiences of people living in different regions of Appalachia, particularly in the coal mining areas of eastern Kentucky or West Virginia, are vastly different than it is for individuals in other places. With this research, we sought to understand those unique regional differences to learn how we can better improve cancer screening and treatment strategies.' Todd Burus, MAS, data scientist at the Markey Cancer Center of the University of Kentucky and first author of the JACS study Some progress, but not enough Using data from the U.S. Census Bureau, the U.S. Cancer Statistics Incidence Analytics Database, and the National Center for Health Statistics, the authors examined cancer incidence and death rates from 2017 to 2021 and overall cancer trends between 2004 and 2021. Some of their main findings were: Targeted strategies can improve care Reasons for these disparities are complex, stemming from limited access to care in rural regions, historical occupational risks from coal mining and other hazardous industries, and higher poverty rates, the authors noted. Other factors, such as higher prevalence of obesity, smoking, and lower HPV vaccination rates, also likely contribute to the widening disparities. Although the disparities are concerning, great strides can be made to close these gaps and improve care, they added. 'From a clinical standpoint, it's important for us to understand the differences in cancer care and overall rates depending upon the region of Appalachia,' said B. Mark Evers, MD, FACS, senior author of the study and director of the Markey Cancer Center. 'Being able to understand where these disparities exist at the county level within Appalachia allows us to better focus our screening techniques and prevention strategies.' Dr. Evers cited recent public health initiatives that helped boost lung cancer screening rates in Kentucky above the national average for at-risk patients. Lung cancer death rates in Appalachia are down by 2.5%, and late-stage lung cancer rates are down by about 2.2%, with the largest period of decline associated with the advent of lung cancer screening recommendations from the U.S. Preventive Services Task Force, according to the JACS paper. These positive trends demonstrate the influence that public health campaigns and targeted interventions can have on at-risk populations, Dr. Evers added. 'There are reasons for hope and opportunities to increase access to preventive care in at-risk populations throughout Appalachia, especially as we learn from this data where to focus on some of these problems that have been persistent for decades,' Dr. Evers said. Study coauthors with Dr. Evers and Mr. Burus are: Pamela C. Hull, PhD; Krystle A. Lang Kuhs, PhD, MPH; Tianyan Gao, PhD; and Christine F. Brainson, PhD
APPLACHIA CANCER DISPARITIES HEALTH OUTCOMES PUBLIC HEALTH SCREENING TREATMENT
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