Trends in endometrial cancer incidence and mortality in Appalachian eastern Kentucky: A focus on obesity, metabolic syndromes, and health disparities.

212 Background: Endometrial cancer significantly impacts the Appalachian population compared to the overall United States population. Evidence supports that this difference may be due to health disparities, which includes access to affordable healthy food, obesity, and metabolic syndromes in addition to care disparities. Methods: We queried the Kentucky Cancer Registry’s online public Cancer Incidence and Mortality Registry to determine changes in age adjusted invasive corpus uteri cancer incidence and mortality rates in Appalachian (AK) and Non-Appalachian Kentucky (NAK) counties over time. Incidence rate ratios were used to analyze the difference in endometrial cancer incidence and mortality between AK and NAK populations across several time periods. The z-test for two population proportions was used to analyze differences in incidence and mortality between AK and NAK. Results: Incidence of endometrial cancer was higher in AK vs. NAK at the beginning (P < 0.002) and end (P < 0.001) of the period examined, although there was no statistically significant difference in mortality between AK vs NAK. Incidence and mortality increased in both AK (P < 0.01) and NAK (P < 0.001) across the period studied. Conclusions: Incidence in endometrial cancer in Appalachian Kentucky was significantly higher than non-Appalachian Kentucky, although mortality was not higher in the final years studied. Lower socioeconomic status, access to affordable nutritious foods, and health likely contributed to an increased incidence of endometrial cancer. With an increase in chronic diseases such as obesity prevailing in AK, there is increased exposure to unopposed estrogen, which increases the risk for developing endometrial cancer and may be reflected in these results. Education and lack of access to healthcare also are contributing factors. Although the cancer care disparities seen in Appalachia are commonly viewed as byproducts of the region’s unique culture, they can also be viewed as local expression of challenges in global oncology facing resource poor, rural regions around the world. Efforts to reduce the risk in Appalachia will require addressing the underlying problems seen in other communities worldwide with rising endometrial cancer incidence – poverty, health literacy, obesity, rising rates of diabetes, exercise and environmental pollution. Year Incidence AK (/100,000) Incidence NAK (/100,000) % Higher Incidence AK Mortality AK (/100,000) Mortality NAK (/100,000) % Higher Mortality AK 2001-2005 25.3 21.0 20.5% 1.6 1.6 0.0% 2006-2010 27.2 22.1 23.1% 1.5 1.6 -6.3% 2011-2015 30.3 24.7 22.7% 2.0 1.7 17.6% 2016-2020 31.8 26.0 22.3% 2.5 2.6 -3.8%