Abstract
BackgroundTennessee women experience the 12th highest breast cancer mortality in the United States. We examined the geographic differences in breast cancer incidence in Tennessee between Appalachian and non-Appalachian counties from 2005 to 2015.MethodsWe used ArcGIS 10.7 geospatial analysis and logistic regression on the Tennessee Cancer Registry incidence data for adult women aged ≥ 18 years (N = 59,287) who were diagnosed with breast cancer from 2005 to 2015 to evaluate distribution patterns by Appalachian county designation. The Tennessee Cancer Registry is a population-based, central cancer registry serving the citizens of Tennessee and was established by Tennessee law to collect and monitor cancer incidence. The main outcome was breast cancer stage at diagnosis. Independent variables were age, race, marital status, type of health insurance, and county of residence.ResultsMajority of the sample were White (85.5%), married (58.6%), aged ≥ 70 (31.3%) and diagnosed with an early stage breast cancer (69.6%). More than half of the women had public health insurance (54.2%), followed by private health insurance coverage (44.4%). Over half of the women resided in non-Appalachian counties, whereas 47.6% were in the Appalachian counties. We observed a significant association among breast cancer patients with respect to marital status and type of health insurance coverage (p = < 0.0001). While the logistic regression did not show a significant result between county of residence and breast cancer incidence, the spatial analysis revealed geographic differences between Appalachian and non-Appalachian counties. The highest incidence rates of 997.49–1164.59/100,000 were reported in 6 Appalachian counties (Anderson, Blount, Knox, Rhea, Roane, and Van Buren) compared to 3 non-Appalachian counties (Fayette, Marshall, and Williamson).ConclusionsThere is a need to expand resources in Appalachian Tennessee to enhance breast cancer screening and early detection. Using geospatial techniques can further elucidate disparities that may be overlooked in conventional linear analyses to improve women’s cancer health and associated outcomes.
Highlights
Tennessee women experience the 12th highest breast cancer mortality in the United States
Full list of author information is available at the end of the article
Appalachian region is defined as the 205,000-squaremile region that stretches from southern New York to northern Mississippi, including 420 counties over 13 states [3]
Summary
Tennessee women experience the 12th highest breast cancer mortality in the United States. We examined the geographic differences in breast cancer incidence in Tennessee between Appalachian and non-Appalachian counties from 2005 to 2015. The burden of breast cancer, varies by the region (rural vs urban) where an individual lives [1, 2]. One out of every three counties in the Appalachian region is considered rural. The Appalachian geography isolates many communities from cities and healthcare resources, where the residents of this region are often described as the “invisible/neglected minority” [4]. Residents of the Appalachian region experience higher rates of poverty, lower levels of literacy, and poorer health outcomes compared to the non-Appalachian region [6, 7]. Cancer mortality rates in the U.S have continuously decreased since 1991, geographical and racial/ethnic disparities in cancer mortality and survival persist [4, 7, 8] in the Appalachian region
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