CDC report shows cancer death rates in Appalachia higher than national

June 28, 2002

Previous studies have shown that rural Americans often have less money, less education and less access to healthcare than other Americans.

A report released June 21, 2002, by the Centers for Disease Control and Prevention (CDC) and conducted by researchers from the University of Kentucky and Penn State University confirms an unfortunate consequence - residents of Appalachia, a largely rural area following the spine of the Appalachian mountains and including a large part of Pennsylvania, are at higher risk of dying from cancer.

For example, those in Pennsylvania who fall within the geographic boundaries of Appalachia were shown to be at greater risk of death from colorectal cancer. (See report and map of Appalachia at

"Whereas some may feel that cancer mortality is high in urban areas because of pollution and various behavioral factors, this report documents that people of Appalachia, particularly those in rural Appalachia, also have high rates of cancer mortality," said Gene Lengerich, VMD, associate professor of health evaluation sciences, Penn State College of Medicine, and research director for the National Cancer Institute-funded Appalachian Cancer Network (ACN) which conducted this study.

Led by the University of Kentucky and in partnership with West Virginia University and Penn State University, the ACN directs cancer research and research-based interventions toward rural areas and medically underserved people. Both the College of Medicine and the College of Agricultural Sciences at Penn State are actively involved with the ACN.

Researchers at University of Kentucky and Penn State University in collaboration with the Centers for Disease Control and Prevention analyzed mortality data from 1994-1998 to compile the report. The data showed that the death rates for all cancers in Appalachia, and particularly in rural counties of Appalachia, were significantly higher than the corresponding death rates for the United States. In particular, death rates for lung and cervical cancer were significantly higher in rural Appalachia. The Appalachian region of Kentucky had the highest death rates for all cancers, lung cancer and cervical cancer. The report states that death rates from colorectal cancer were especially high in the Appalachian area of Pennsylvania.

"I think that this report for the first time really clarifies the disparity experienced by the medically underserved rural parts of Appalachia," said Ann Ward, director and co-principal investigator for the Northern Region of the ACN. "Other studies have shown that minority groups experience cancer disparities. This study shows that disparities also exist for a very large population in this geographic region."

High rates of smoking in Appalachia certainly contribute to high cancer death rates, but limited access to healthcare and lack of insurance probably also contribute to these high death rates, Ward said. However, she points out that other seldom mentioned reasons include the lack of medical specialists in rural areas and fear among some rural Americans of medical interventions.

Ward and Lengerich agree that local communities can help rural residents effectively reduce their risk of cancer, seek care, and assist physicians who can provide the necessary cancer tests.

"I would like to see researchers, policy makers and health educators take the information from this report and address this disparity," Ward said. "The ACN is particularly well-positioned to do this through the College of Agricultural Sciences where our regional office is located. Through our work, Penn State Cooperative Extension educators can use the research done through ACN to provide evidence-based cancer education programs to the rural communities of Pennsylvania and New York."

Lengerich said this report particularly points to a need for studies to look at the occurrence of cancer, not just death from cancer, in Appalachia. Comparing the occurrence of cancer in Appalachia to that in the United States could shed light on whether people of Appalachia are actually receiving care similar to that received by the rest of the United States.

"Research in cancer communication, education and health care can help educators, doctors, nurses, and policy makers to better overcome these disparities," Lengerich said.

Penn State

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