Year of Publication



Public Health

Date Available


Degree Name

Dr. of Public Health (Dr.P.H.)

Committee Chair

James Holsinger, Jr., MD, PhD

Committee Member

Sarah Wackerbarth, PhD

Committee Member

Richard Ingram, DrPH



For many years Kentucky has had the nation’s highest lung cancer incidence. Kentucky is one of the thirteen states in Appalachia in which the difference in wealth is a key determinant of health, since residents of Appalachia do not have access to the same financial resources as the rest of the US population. The disparities in lung cancer mortality within the Commonwealth of Kentucky are not completely clear, but some postulate that poor access to care or substandard care may contribute. In this study the value of lung cancer treatment for a medically underserved population (Appalachia) will be evaluated based on health insurance type and treatment pattern. This study will also identify factors which have an effect on lung cancer treatment as well as factors that determine the benefits of lung cancer survival and the mortality risk.


Data for lung cancer cases diagnosed between 2000 and 2011 were obtained from the Kentucky Cancer Registry (KCR). The cohort included 49,512 patients who met the following inclusion criteria: Lung cancer was their first diagnosed cancer Stage 0 through IV. Patients were classified into two distinct groups based on county location: Appalachian and Non-Appalachian. Chi-square, Cox survival regression analysis, and Kaplan Meier survival trend were performed to identify variables affecting treatment and survival.


The analysis evaluated 49,512 patients from KCR. For all population, sex (p<.0001), age group (p<.0001), Stage (p<.0001), insurance type (p<.0001) and county (p<.0001) were significantly associated with the type of treatment. Variables such as sex, race, age, Stage, treatment, insurance, and tobacco were significantly associated with survival in Non-Appalachia, while the Appalachia variable race was not significant for affecting survival. Median survival time was higher for the private insurance population both in Non-Appalachia and Appalachia regions.


Even though the strongest predictors for survival in lung cancer are age and cancer Stage, health insurance does have a significant impact on improving survival. Health insurance provides access to recommended treatment. The medically underserved population received standard lung cancer treatment covered by the Medicaid and Medicare health plans. Over all, early diagnosis and timely follow up are imperative for improving value care in lung cancer treatment.

Included in

Public Health Commons