Year of Publication



Public Health

Date Available


Degree Name

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

Committee Chair

Thomas Tucker, PhD, MPH

Committee Member

Jaclyn McDowell, DrPH

Committee Member

Beth Lacy, PhD


Objectives: Prostate cancer (CaP) is the most common site of cancer in men in the United States and is very treatable when diagnosed in localized and regional stages. While there are widely available forms of screening that can detect CaP in its early stages, factors that can affect healthcare access such as health insurance, race, and Appalachian residency have been linked with differences in rates of distant-stage CaP diagnosis. This study aimed to explore the relationships between health insurance, race, Appalachian residency, and late-stage CaP diagnosis in the state of Kentucky.

Methods: A sample of 26,622 men from the state of Kentucky collected between January 1st, 2011 and December 31st, 2020 was analyzed using data collected by the Kentucky Cancer Registry. Bivariate and multivariate analyses were conducted to examine the relationships between these variables and stage at diagnosis.

Results: Significant bivariate associations were found between late-stage diagnosis and age (p<0.0001), race (p=0.0147), Appalachian residency (p=0.0007), and primary insurance payer (p<0.0001). In the logistic regression analysis, increasing age (AOR: 1.070 per year), being a Black man (AOR: 1.477 compared with White/Unknown/Other) being uninsured (AOR: 5.054 compared with privately insured), using Medicaid (AOR: 4.198), using Medicare (AOR: 1.598), and Appalachian residency (AOR: 1.131 compared with non-Appalachian residents) were all significantly associated with having higher odds of receiving a late-stage CaP diagnosis.

Conclusions: All of the variables analyzed were significantly associated with differences in odds of late-stage CaP diagnoses, with people who are uninsured and Medicaid-users having the largest increase in odds. The identification of these barriers to healthcare and the mechanisms by which they work is a vital step in crafting policy that can better address these disparities.

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