College of Medicine, University of Kentucky, Lexington, KY 40536, USA.
Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA.
Int J Environ Res Public Health. 2023 Jul 14;20(14):6363. doi: 10.3390/ijerph20146363.
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.
受教育程度低、癌症发病率和死亡率高一直是肯塔基州阿巴拉契亚地区面临的挑战。先前的研究报告了阿巴拉契亚地区和非阿巴拉契亚地区之间癌症发病率和死亡率的差异，但教育对这种差异的影响尚未得到广泛研究。在此，我们将所有癌症以及两个具有筛查条件的癌症部位（结直肠癌和肺癌）与教育指标（受教育程度和读写能力）以及所有 120 个肯塔基州各县的一个地理指标相结合。使用该数据集绘制了专题地图，并进行了简单的线性和空间回归，以评估统计学意义，并衡量阿巴拉契亚和非阿巴拉契亚肯塔基州县级教育与癌症相关结果之间线性关系的强度。在所有癌症部位中，调整年龄后的癌症发病率和死亡率在阿巴拉契亚地区高于非阿巴拉契亚地区的肯塔基州。未完成高中学业的人口比例与阿巴拉契亚地区结直肠癌和肺癌发病率和死亡率的上升呈正相关。同样，人口中基本读写能力不足比例较高的县与结直肠癌和肺癌的发病率和死亡率相关性最强，这些地区集中在阿巴拉契亚地区的肯塔基州。我们的研究结果表明，需要实施增加教育程度和提高基本读写能力的干预措施，以改善阿巴拉契亚地区的癌症预后。
