Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Wayne Sanderson, PhD, MS

Committee Member

David Mannino, MD

Committee Member

Steven Browning, PhD


Mesothelioma is one of the most aggressive cancers in the United States and around the world, with a grim 5-year survival rate of only 8%. After diagnosis there is little that can be done to stop the progression of the disease. Smoking has been negatively associated with mesothelioma survival. This may be due to several factors including increased oxidative stress or sequestration of tobacco-related carcinogenic compounds by asbestos fibers trapped in the lung. This study investigated the association between smoking and mesothelioma survival in the Kentucky population. It examines the risk of living in the low socioeconomic region of Appalachian Kentucky. This study is a population-based study that included those diagnosed with mesothelioma as reported by the Kentucky Cancer Registry (KCR) between 1995 and 2011. The KCR is a Surveillance, Epidemiology, and End Results (SEER) organization that has maintained gold standard certification since it was founded. Stage at diagnosis was significantly associated with survival rate. Cox proportional hazard multivariable model describing mesothelioma survival from all deaths was separated by stage: early, late, and unknown. Smoking was strongly associated with late stage mesothelioma diagnosis with a HR of 1.528 (p = 0.0057). However there was no significant difference in survival between Appalachian and non-Appalachian residents. This study suggests that cigarette smoke exposure may decrease survival of mesothelioma.

Included in

Public Health Commons