title: Comparative analysis of invasive cervical cancer incidence rates in three Appalachian states.
abstract: 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.
authors.affiliation: College of Public Health, University of Kentucky, Lexington, KY 40504, USA. cmhope0@uky.edu
authors.forename: Claudia
authors.initials: C
authors.lastname: Hopenhayn
authors.forename: Heather
authors.initials: H
authors.lastname: Bush
authors.forename: Amy
authors.initials: A
authors.lastname: Christian
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Shelton
mesh_terms: D000328:Adult; D001061:Appalachian Region / Q000453:epidemiology; D005260:Female; D006801:Humans; D009361:Neoplasm Invasiveness; D011159:Population Surveillance; D012044:Regression Analysis; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*