Comparative analysis of invasive cervical cancer incidence rates in three Appalachian states

Claudia Hopenhayn, Heather Bush, Amy Christian, Brent J. Shelton

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Background. Invasive cervical cancer (ICC) rates remain elevated in the Appalachian region of the United States. We investigated patterns of invasive cervical cancer incidence rates in three Appalachian states (Kentucky, West Virginia, Pennsylvania) to uncover specific high-risk subgroups within this large and heterogeneous region. Methods. The analysis was conducted for the three states combined and individually. Invasive cervical cancer rates were characterized by individual and county-level sociodemographic variables, including age, race, poverty, education, Appalachian status, and rural/urban status. Bivariate analyses and multivariable Poisson regression models were conducted to address the relative contributions of each variable to the risk of invasive cervical cancer. Results. The three states differed in the contribution of each factor to the risk of invasive cervical cancer. The overall invasive cervical cancer incidence rates for Kentucky, West Virginia, and Pennsylvania were 13.4, 13.9, and 10.2 per 100,000/yr, respectively. After controlling for other demographic variables, the effect of Appalachian status on invasive cervical cancer was weaker, while rural status, education, and race were stronger, significant predictors. Conclusions. This study illustrates the heterogeneity of population demographics and invasive cervical cancer risk, and the need to identify subregions and subgroups within Appalachia at highest risk for this disease.

Original languageEnglish
Pages (from-to)859-864
Number of pages6
JournalPreventive Medicine
Issue number5-6
StatePublished - Nov 2005

Bibliographical note

Funding Information:
This research was supported by the American Cancer Society and the Appalachia Cancer Network. Special thanks to W. Jay Christian for his contribution with mapping data.


  • Appalachia
  • Cervical cancer
  • Incidence rates
  • Kentucky
  • Pennsylvania
  • Rural
  • West Virginia

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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