
==== Front
Lancet Reg Health Am
Lancet Reg Health Am
Lancet Regional Health - Americas
2667-193X
Elsevier

S2667-193X(24)00188-1
10.1016/j.lana.2024.100861
100861
Correspondence
Appalachia’s worsening disparities in cancer mortality should be viewed as a regional manifestation of widening global disparities in health outcomes rather than a uniquely American phenomena
Sabharwal Kennedy a
Garcia Oscar b
Miller Robert C. Miller.Robert@Mayo.edu
c∗
a University of Kentucky College of Medicine, Lexington, KY, USA
b Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
c Emeritus Office, Mayo Clinic, Rochester, MN, USA
∗ Corresponding author. Emeritus Office, Mayo Clinic, 200 1st Street SW, Rochester, MN 55902, USA. Miller.Robert@Mayo.edu
12 8 2024
9 2024
12 8 2024
37 10086115 7 2024
25 7 2024
29 7 2024
© 2024 The Author(s)
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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pmcWe would like to bring to the readership’s attention the continued worsening of cancer mortality in the U.S. Appalachian Mountains. Cancer is the leading cause of death in the region. Disparities in outcomes between the Appalachia and Non-Appalachian people of Kentucky have worsened over the last thirty years.1,2

Appalachian regional health disparities, worsened by persistent stereotypes, are often framed as a unique challenge tied to cultural practices, geography, poverty, coal extraction, and widespread use of tobacco products. In our experiences providing patient care to the Appalachian people of Eastern Kentucky, we have witnessed firsthand the biases that lead to healthcare providers placing the blame for poor outcomes on the Appalachian people themselves, cultural values, and lifestyles.

Rather than a uniquely American problem, Appalachia’s health disparities can be viewed as one regional manifestation of widening global disparities in health outcomes and healthcare investment between growing, economically successful urban regions and rural, impoverished areas, particularly in regions with sizable resource extraction industries.3 Resource extraction regions are impacted by global economic forces originating outside their locales and create a boom–bust cycle leading to economic degradation, poverty, and social fragmentation, such as has occurred in deindustrialized coal rich regions of Appalachia.4,5 Appalachia in this regard bears more similarity to these global regions than wealthier urban portions of the United States. Solutions aimed at addressing these disparities should take this into account.

Contributors

Literature search–KS and RCM.

Figures–N/A Study design–N/A.

Data collection–N/A.

Data Analysis–N/A.

Data interpretation–N/A.

Writing: Original Draft–KS, OG, RCM.

Writing: Review and editing–KS, OG, RCM.

Kennedy Sabharwal–KS Oscar Garcia–OG Robert C. Miller—RCM.

Declaration of interests

RCM accepted funding in the past from the American Society for Radiation Oncology (ASTRO) for editorial duties. KS and OG no conflicts of interest to report.

Acknowledgements

Funding Source: No funding.
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References

1 Blackley D. Behringer B. Zheng S. Cancer mortality rates in Appalachia: descriptive epidemiology and an approach to explaining differences in outcomes J Commun Health 37 4 2012 804 813 10.1007/s10900-011-9514-z
2 Hudson L. Burus T. Park L. Huang B. Hull P.C. Vanderford N.L. Cancer disparities in appalachian Kentucky J Rural Health 40 1 2024 87 95 10.1111/jrh.12763 37095596
3 Strasser R. Rural health around the world: challenges and solutions Fam Pract 20 4 2003 457 463 10.1093/fampra/cmg422 12876121
4 Eller R.D. Miners, millhands, and mountaineers: industrialization of the appalachian South, 1880-1930 1982 University of Tennessee Press Knoxville
5 Weeks W.B. Chang J.E. Pagán J.A. Rural-urban disparities in health outcomes, clinical care, health behaviors, and social determinants of health and an action-oriented, dynamic tool for visualizing them PLoS Glob Public Health 3 10 2023 e0002420 10.1371/journal.pgph.0002420
