METHODS. Forty-four states and the District of Columbia provided informationfor the diagnosis years 2001 through 2003 from cancer registries that met highquality data criteria. Eleven of 13 states with counties in Appalachia, covering 88% of the Appalachian population, met these criteria; Virginia and Mississippi were included for 2003 only. SEER*Stat was used to calculate age-adjusted rates per 100,000 population and 95% gamma confidence limits. RESULTS.Overall, cancer incidence rates were higher in Appalachia than in the rest of the US; the rates for lung, colon/rectum, and other tobacco-related cancers were particularly high. Central Appalachia had the highest rates of lung (men: 143.8; women: 75.2) and cervical cancer (11.2)-higher than the other 2 regions and the rest of the US. Northern Appalachia had the highest rates for prostate, female breast, and selected other sites, and Southern Appalachia had the lowest overall cancer incidence rates.CONCLUSIONS. Cancer incidence rates in Appalachia are higher than in the rest of the US, and they vary substantially between regions. Additional studies are needed to understand how these variations within Appalachia are associated with lifestyle, socioeconomic factors, urban/rural residence, and access to care.

An investigation of the occurence of multiple sclerosis (MS) was undertaken in the City of Galion, Ohio, USA, because of a report of an increased number of cases. As of June 1,1987, there were 18 living cases of MS in Galion and Polk Township, for a prevalence rate of 112 cases per 100,000 population. The expected rate is approximately 65–170 cases per 100,000. In a case-control study, residents of Galion or Polk Township who had MS were compared to residents who did not have MS. The controls were matched to the cases on age and sex and had lived in Galion for at least as long as their matched case. The cases and controls did not differ in the distribution of their present or past Galion addresses, occupational histories or workplace exposures. Cases were more likely to have graduated from high school and college than controls. Cases were more likely than controls to report a history of allergies, to recall two or more relatives who had neurologic diseases that began before their first MS symptoms, to report owning a cat that died of unexplained causes and to recall having received oral polio vaccine. Cases and controls had similar levels of antibodies to measles, chickenpox, cytomegalovirus and the human T-cell lymphotrophic virus I.

Raised death rates have been reported for non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) among white male residents of Hancock County, Ohio, United States, for 1960-79. As a surveillance activity, to assess the possibility of workplace exposures contributing to these raised rates, a case-control study was conducted using death certificate records of white male Hancock County residents for 1958-83. There were 61 cases of NHL, 15 cases of HD, and 304 control subjects (chosen as a stratified random sample) in the study. Cases and controls were compared with respect to their usual occupation and industry statements on the death certificates, adjusting for age at death and year of death. Summary odds ratios (OR) and test-based 95% confidence intervals (CI) were calculated. NHL was associated with the occupation of farmer (OR = 1.6; CI = 0.8, 3.4; observed number of exposed cases (Obs) = 15). The association was restricted to 1958-73 (OR = 2.1; CI = 0.9, 4.8; Obs = 13). The three cases of HD among farmers occurred in a cluster in the 15-64 age range during 1958-63 (OR = 21.2). The results for occupations and industries other than farming were based on small numbers and were unremarkable. This small study adds to the growing body of reports linking farming and malignant lymphoma, particularly NHL.

Death certificate of children less than 8 years of age who were killed between 1979 and 1986 were linked to their Ohio birth certificates and compared with those of Ohio children born in 1983 (controls). Having an unmarried mother increased risk of homicide almost fivefold (odds ratio 4.87). Having a teenage mother, a mother who had not graduated from high-school, and being of Black race or low birthweight each increased the risk by approximately threefold. Increases in the proportion of children born to unmarried mothers may contribute to increases in childhood homicide rates.

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