Geographic Disparities in the Decline of Lung Cancer Mortality among Women in the United States Open Access

Abstract

Lung cancer death rates began declining among women in the United States in 2002; little is known about spatial distribution of this decline among counties, which may have unique trends that are masked when only considering state or national rates. We examined spatiotemporal trends in county-level change in mortality among women in the U.S. from the national peak in 2002 to 2014, and quantified trends in spatial structure and geographic disparity in mortality over time. We obtained county-level mortality rates from the National Vital Statistics System from 1978 to 2014, and used a random effects Poisson model to produce smoothed estimates of change from 2002 to 2014. Local autocorrelation analysis was used to identify spatial clustering in the rates of decline, and mean log deviation (MLD) and between group variance (BGV) were used to measure relative and absolute disparity at the county-, state- and regional level. Demographic and socioeconomic characteristics of clusters were described using data from the 2010 U.S. Census. We identified substantial geographic heterogeneity in the decline of lung cancer death rates among women, including a cluster of 806 counties in the Midwest and central Appalachia with slow declines in lung cancer death rates. Absolute disparity in lung cancer death rates among women has been increasing at each geographic level since 1978, and relative disparity began increasing after the national decline in lung cancer mortality in 2002. Coordinated, targeted public health intervention could reduce the excess burden of lung cancer among women living in the Midwest and Central Appalachia and prevent widening geographic inequity.

Table of Contents

Table of Contents

• BACKGROUND.. 1
• Introduction. 1
• Definition of lung cancer 1
• Trends in lung cancer incidence, mortality, and survival in the United States. 2
• Cigarette smoking and lung cancer 2
• History of tobacco use and cigarette smoking. 3
• Gender-specific trends in cigarette smoking. 4
• Geographic heterogeneity in smoking and tobacco control 5
• Geographic heterogeneity in lung cancer incidence and mortality in women. 6
• Area-level factors associated with lung cancer 7
• Previous studies on county-level lung cancer mortality trends. 9
• Public health implications and study purpose. 9
• INTRODUCTION.. 11
• METHODS. 14
• RESULTS. 17
• DISCUSSION.. 22
• PUBLIC HEALTH IMPLICATIONS AND FUTURE DIRECTIONS. 26
• REFERENCES. 27
• TABLES AND FIGURES. 34

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	spatial analysis cancer epidemiology health disparities
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University
Committee Members	Jemal, Ahmedin , Emory University
Partnering Agencies	National or regional non-profit organization (e.g., American Cancer Society)

Last modified

Primary PDF

Thumbnail	Title	Date Uploaded	Actions
	Geographic Disparities in the Decline of Lung Cancer Mortality among Women in the United States ()	2018-08-28 16:08:43 -0400	Press to Select an action Download

Supplemental Files

Thumbnail	Title	Date Uploaded	Actions