The Relationship between Educational Attainment and Lung Cancer Mortality in Kentucky: Implications for Nurses

Context: The professional literature indicates health has a positive correlation with socioeconomic status. More specifically, prior research documents heightened rates of lung cancer incidence and mortality in Appalachia, a region plagued by persistent poverty and below-average educational attainment. This study analyzed predictors of lung cancer mortality within Kentucky, a predominantly rural state in central Appalachia. Purpose: To determine whether county-level lung cancer mortality is related to counties’ high school graduation rates, per capita personal income levels and adult smoking rates. Also, to test whether significant differences exist among these variables between Kentucky’s Appalachian and nonAppalachian counties. Methods: Data from the Kentucky Institute of Medicine’s 2007 report The Health of Kentucky: A County Assessment were analyzed using independent samples t tests, bivariate correlations and regression analyses. Results: On a statewide basis, inverse associations were found between county-level lung cancer mortality and counties’ graduation rates (p < .001) and per capita personal income (p < .01). Statistically significant differences were detected between Kentucky’s Appalachian and non-Appalachian regions for each variable except adult smoking rates. Conclusions: In the context of similar adult smoking rates between the state’s Appalachian and nonAppalachian counties, high school graduation rates showed the strongest statistical association with lung cancer mortality. This indicates that continued improvements in Kentucky’s rate of diploma attainment may contribute to future reductions in lung cancer mortality statewide. These findings suggest practice and policy implications for nurses in Kentucky and, potentially, other states with low educational attainment and high lung cancer mortality.