Description of a Lung Cancer Hotspot: Disparities in Lung Cancer Histology, Incidence, and Survival in Kentucky and Appalachian Kentucky

Christine F. Brainson, Bin Huang, Quan Chen, Laurie E. McLouth, Chunyan He, Zhonglin Hao, Susanne M. Arnold, Ralph G. Zinner, Timothy W. Mullett, Therese J. Bocklage, David K. Orren, John L. Villano, Eric B. Durbin

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Introduction: Kentucky is recognized as the state with the highest lung cancer burden for more than 2 decades, but how lung cancer differs in Kentucky relative to other US populations is not fully understood. Patients and Methods: We examined lung cancer reported to the Surveillance, Epidemiology, and End Results (SEER) Program by Kentucky and the other SEER regions for patients diagnosed between 2012 and 2016. Our analyses included histologic types, incidence rates, stage at diagnosis, and survival in Kentucky and Appalachian Kentucky relative to other SEER regions. Results: We found that both squamous cell carcinomas and small-cell lung cancers represent larger proportions of lung cancer diagnoses in Kentucky and Appalachian Kentucky than they do in the SEER registries. Furthermore, age-adjusted cancer incidence rates were higher in Kentucky for every subtype of lung cancer examined. Most notably, for Appalachian women the rate of small-cell carcinomas was 3.5-fold higher, and for Appalachian men the rate of squamous cell carcinoma was 3.1-fold higher, than the SEER rates. In Kentucky, lung cancers were diagnosed at later stages and lung cancer survival was lower for adenocarcinoma and neuroendocrine carcinomas than in SEER registries. Squamous cell carcinomas and small-cell carcinomas were most lethal in Appalachian Kentucky. Conclusion: Together, these data highlight the considerable disparities among lung cancer cases in the United States and demonstrate the continuing high burden and poor survival of lung cancer in Kentucky and Appalachian Kentucky. Strategies to identify and rectify causes of these disparities are discussed.

Original languageEnglish
Pages (from-to)e911-e920
JournalClinical Lung Cancer
Issue number6
StatePublished - Nov 2021

Bibliographical note

Funding Information:
Supported in part by NIGMS P20 GM121327-03, NCI R01 CA237643, American Cancer Society Research Scholar Grant 133123-RSG-19-081-01-TBG, and American Association for Cancer Research Innovation and Discovery Grant (CFB). Also supported by the Biostatistics & Bioinformatics Shared Resource Facility and the Cancer Research Informatics Shared Resource Facility of the University of Kentucky Markey Cancer Center (P30 CA177558). LEM was supported by R03 CA235171 and ACS IRG # 16-182-28.

Publisher Copyright:
© 2021 Elsevier Inc.


  • Appalachia
  • Disparities
  • Interventions
  • Small cell
  • Squamous

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research


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