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SUMMARY
This report summarizes initial descriptive findings from a survey of Federal superfund site files in the three state Appalachian region. The report serves as a primer on environmental epidemiological approaches necessary to address and answer community beliefs and concerns about perceived higher than average cancer deaths thought to be due to environmental causes. Significant data gaps were found in report files. The report explains factors (e.g, additional personal exposures and lifestyle choices) that prevent formation of causal theories about environmental exposures and cancer. The report establishes high prevalence of two environmental factors, superfund sites and radon concentrations, throughout the region. However, a simple spatial analysis comparing superfund sites with cancer mortality rates was inconclusive.
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FINDINGS
4.1 Appalachia (counties located in the 13 states) has an elevated number of counties in the worst two deciles (worst 20%) of cervical cancer mortality (24% vs. 17%). The number of Appalachian counties in the worst 2 deciles of cervical cancer mortality is double the national percentage (34% vs. 17%).
4.2 Focusing on the special problems of economically “distressed counties” designated by the Appalachian Regional Commission is fruitful way to improve cervical cancer outcomes in Appalachia, and therefore address one of the most prominent cervical cancer disparities in the nation.
4.3 In non-distressed Appalachian counties, 15% more women than would have died if Appalachian mortality rates were the same as the national average during that time period. In the 95 distressed counties, 42% more women than would have died if Appalachian mortality rates were the same as national rates.
4.4 The HPSA designation and persistently distressed designation of counties did not overlap as tightly as we expected. For non-Appalachian counties within the 13 states, there is a relationship between HPSA designation and number of counties in the worst two deciles of cervical cancer mortality. However in Appalachia this relationship does not hold, as the risk for an Appalachian county placing it in the worst 20% of cervical cancer mortality does not differ for HPSA and non-HPSA designated counties.
4.5 We found no relationship between how rural the county is, and its level of cervical cancer mortality.
4.6 Future research, health policies, and interventions consider distressed status as a useful indicator (as opposed to rural counties or HPSA counties) in addressing cervical cancer disparities.
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