Abstract
PurposeThe purpose was to determine whether Appalachian residence alone or in combination with violence was linked to poorer quality of life (QOL).MethodsWomen recently diagnosed and included in either the Kentucky or North Carolina Cancer Registries were interviewed by phone between 2009 and 2015 (n = 3320; mean age = 56.74). Response rates were similar by state (40.1 in Kentucky and 40.9% in North Carolina). Appalachian (N = 990) versus non-Appalachian residents (N = 2330) were hypothesized to have poorer QOL defined as (a) lower Functional Assessment of Cancer Therapy—General (FACT-G) scores and (b) more symptoms of depression, stress, or comorbid physical conditions. Lifetime intimate partner or sexual violence was first investigated as a moderator then mediator of regional differences. Multiple analyses of covariance (MANCOVA) models were used.ResultsViolence modified the effect of Appalachian residence on poorer QOL outcomes; FACT-G total scores (p = .02) were lowest for women living in Appalachia who had additionally experienced violence. Socioeconomic indicators appeared to mediate or explain differences in QOL outcomes by Appalachian residence such that when adjusting for income, education and insurance, Appalachian residence remained associated only with poorer physical QOL outcomes (p < .05).ConclusionsWhile violence rates did not differ by residence, the combined effect of living in Appalachia and experiencing violence resulted in significantly greater impact on poorer QOL among women recently diagnosed with cancer. Clinical consideration of patients’ residence, socioeconomic status and violence experienced may help identify and mitigate the longer-term impact of these identifiable factors associated with poorer QOL.
Highlights
Appalachia is recognized by the National Institute on Minority Health and Health Disparities as an under-resourced and medically underserved region due in part to its physical isolation, rurality, and poverty
Women who lived in Appalachian counties were more likely to be White, to currently smoke, live in rural counties, have less education, have lower monthly household incomes, and were less likely to have private health insurance than women living in non-Appalachian counties (Table 1)
Our findings indicate that socioeconomic differences by Appalachian residence explained regional differences in quality of life (QOL) outcomes with the important exception that poorer physical QOL remained associated with Appalachian residence
Summary
In addition to poverty and physical isolation, Appalachian Kentucky in particular has long been characterized by reduced health care access [6,7,8,9] yet the needs for health care are greater in this region. Despite evidence that patient navigators are effective in improving cancer diagnostic outcomes in medically underserved areas [13], Anderson et al [14] found that many cancer care centers in Appalachia did not have patient navigator services. This finding provides additional evidence that those diagnosed with cancer in Appalachian may be at greater risk of poorer cancer outcomes
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
