Abstract
Low educational attainment and high cancer incidence and mortality rates have long been a challenge in Appalachian Kentucky. Prior studies have reported disparities in cancer incidence and mortality between Appalachian and non-Appalachian populations, but the influence of education on this disparity has not been extensively studied. Herein, all cancers and two cancer sites with available screenings (colorectal and lung) were joined with education indicators (educational attainment and literacy) and one geographic indicator across all 120 Kentucky counties. This dataset was used to build choropleth maps and perform simple linear and spatial regression to assess statistical significance and to measure the strength of the linear relationship between county-level education and cancer-related outcomes in Appalachian and non-Appalachian Kentucky. Among all cancer sites, age-adjusted cancer incidence and mortality was higher in Appalachian versus non-Appalachian Kentucky. The percentage of the population not completing high school was positively correlated with increased colorectal and lung cancer incidence and mortality in Appalachia. Similarly, counties with a higher percentage of the population lacking basic literacy had the strongest correlation with colorectal and lung cancer incidence and mortality, which were concentrated in Appalachian Kentucky. Our findings suggest a need for implementing interventions that increase educational attainment and enhance basic literacy as a means of improving cancer outcomes in Appalachia.
Document Type
Article
Publication Date
7-2023
Digital Object Identifier (DOI)
https://doi.org/10.3390/ijerph20146363
Funding Information
This study was supported by the University of Kentucky’s Appalachian Career Training in Oncology (ACTION) Program (NCI R25 CA221765), the Markey Cancer Center Cancer Center Support Grant (NCI P30 CA177558), the NIH National Center for Advancing Translational Sciences Grant (UL1TR00199) (NMR), and the Infectious Disease Society of America 2021–2022 Grant for Emerging Researchers/Clinicians Mentorship (G.E.R.M.) program (NMR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Repository Citation
Robertson, Nicole MPH; Burus, Todd; Hudson, Lauren; Hull, Pamela C.; Park, Lee; and Vanderford, Nathan L., "Lung and Colorectal Cancer Disparities in Appalachian Kentucky: Spatial Analysis on the Influence of Education and Literacy" (2023). Markey Cancer Center Faculty Publications. 362.
https://uknowledge.uky.edu/markey_facpub/362
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Notes/Citation Information
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).