Year of Publication



Public Health

Date Available


Degree Name

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

Committee Chair

Thomas Tucker, PhD

Committee Member

Jaclyn McDowell, DrPH

Committee Member

Steven Browning, PhD


Colorectal cancer is the third most commonly diagnosed cancer in the United States. Historically, the Appalachian region of Kentucky has experienced disparities in colorectal cancer screening and survival as compared to both the non-Appalachian region of the state and the United States. The aim of this paper is to investigate the differences in cancer staging and survival after diagnosis in Appalachian and non-Appalachian Kentuckians. The present time period of study is a retrospective, population-based cohort with data taken from the Kentucky Cancer Registry. Binomial logistic regression and Cox proportional hazards models were used to estimate unadjusted and adjusted odds ratios and hazard ratios, respectively. Of colorectal cancer cases, 61% of Appalachian (n=1875) and 58.8% of non-Appalachian (n=3843) cases were late stage. There were 749 colorectal cancer related deaths among Appalachians and 1527 deaths among non-Appalachians. A multivariable binomial logistic regression model found the odds of late-stage cancer diagnosis were 1.08 (95% CI: 0.99-1.18) times higher for Appalachians. A multivariable Cox proportional hazards model found the hazards of cancer related mortality were 1.03 (95% CI: 0.94-1.13) times higher for Appalachians. Both adjusted models produced insignificant associations between Appalachian residence and the outcomes of interest. Further investigation is needed to fully understand the factors that influence cancer disparity in Appalachia.

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