Abstract
BACKGROUND: The Appalachian region is a large geographic and economic region in the United States (US), representing 7.69% of the US population. This region is more rural, whiter, older, and residents are more likely to be under the poverty line as compared to the rest of the US. Limited research has been done on primary brain and other CNS tumor epidemiology in this region. In this analysis we characterized their incidence patterns. METHODS: Data from 2006–2015 were obtained the Central Brain Tumor Registry of the US. Appalachian counties were categorized using the Appalachia Regional Council scheme. Overall and histology-specific age-adjusted incidence rates per 100,000 population were generated by region, sex, race, and age groups. RESULTS: Overall incidence within Appalachia was 22.62 per 100,000, which is not significantly different from the rest of the US (22.77, p=0.1189). Malignant incidence was 5% higher in Appalachia (7.55/100,000 as compared to 7.23/100,000, p<0.0001), while non-malignant incidence was 3% lower (15.07/100,000 as compared to 15.51/100,000, p<0.0001). The largest differences in histology-specific incidence were in oligodendroglioma, where non-Appalachian incidence was 24% higher (p<0.0001), and hemangioma, where Appalachian incidence was 20% higher (p<0.0001). Among Blacks, incidence of both malignant and non-malignant tumors was 8% lower in Appalachia as compared to the rest of the US (p<0.0001). Incidence was also lower in White Hispanics, where malignant incidence was 19% lower, and non-malignant incidence was 30% lower (p<0.0001). CONCLUSION: Evaluating place-based health disparities is critical to understanding population variation in incidence. Appalachian counties have increased malignant and decreased non-malignant brain tumor incidence as compared to the rest of the US. Incidence of non-malignant tumors was lower among all racial/ethnic groups, with the largest differences in Blacks and White Hispanics. These differences may be attributable to access to health care.