Year of Publication



Public Health

Degree Name

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

Committee Chair

Jay Christian, PhD

Committee Member

Sabrina Brown, DrPH

Committee Member

Eric Durbin, DrPH, MS

Committee Member

Thomas Tucker, PhD



Childhood cancer poses a significant public health burden, both globally and in the United States (US). The most common childhood cancers affect the brain and central nervous system (CNS). Age-adjusted childhood brain tumor (CBT) incidence rates in Kentucky are larger than in the rest of the US; these rates are also higher in Appalachian Kentucky than in the rest of the state. This study determined if high-rate clusters of either CNS tumor or retinoblastoma existed in Kentucky.


Data for this study were retrieved from the Kentucky Cancer Registry for the years 1995 through 2014. Cases were individuals between the ages of 0 and 19 years that were diagnosed with either retinoblastoma (N=81) or a CNS tumor (N=1042). Population data for demographic subgroups defined by binary combinations of age, sex, and race were obtained from the CDC WONDER Bridged-Population database. Spatial scan statistics, used to identify high-rate clusters of CBT, were implemented using SaTScan Version 9.4.4. Clusters were mapped using ArcGIS version 10.4.1.


One significant high-rate cluster of CNS tumor cases was identified across the northern part of Appalachian Kentucky and northern and central parts of Kentucky (p < 0.0 001), but there were no significant high-rate clusters of retinoblastoma cases.


The significant cluster identified by the spatial scan statistic somewhat corresponds to previous findings indicating a higher rate of these cancers in the Appalachian region, but it was not confined to Appalachia. Future aims of this pilot study are to identify possible risk factors that may be causing this increase.

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