All ETDs from UAB

Advisory Committee Chair

Cora Beth Lewis

Advisory Committee Members

Elizabeth Brown

Burt Nabors

Document Type


Date of Award


Degree Name by School

Master of Science (MS) School of Public Health


Purpose: Gliomas are the most common primary brain tumor in adults in the US with an annual age-adjusted incidence rate of 4.67 to 5.73 per 100,000 persons. Exposure to ioniz-ing radiation is the only established risk factor for non-hereditary glioma risk. There are several sources of carcinogenic contaminants in northeast Alabama and western Georgia with the Coosa River serving as the region’s primary water source. In this study, we aimed to examine the incidence rate of glioma in northeast Alabama compared to the rest of the state as well as the association of possible environmental exposure on disease risk and outcomes. Methods: This is a retrospective cohort study that included adult patients (≥20 years at diagnosis) from Alabama with a histopathological diagnosis of glioma, who presented to our institution between January 2015 and December 2019. We calculated the annual age-adjusted incidence rate (AAA-IR) among residents in counties intersected by the Coosa River in northeast Alabama (exposed group) and compared to the AAA-IR in the rest of the state (non-exposed group). The electronic medical records of the participants were re-viewed for patient demographics, socioeconomic status, tumor characteristics, and vital status. The overall survival was assessed using both univariable and multivariable analyses. Results: A total of 660 patients were included in this study (528 non-exposed, and 132 exposed). The AAA-IR of glioma in Alabama was 3.2 per 100,000 persons. The AAA-IR of glioma in the exposed group was 4.76 per 100,000 persons vs 3.14 per 100,000 persons in the non-exposed group with a 50 % higher incidence rate of glioma in the exposed group (RR = 1.50; 95% CI, 1.22-1.89). There was no statistically significant difference between the two groups with respect to tumor characteristics or overall survival. Conclusions: Our findings indicate a significantly higher incidence of glioma in northeast Alabama compared to the rest of the state, which could be associated with environmental exposure. Future geospatial and prospective studies are needed to identify possible envi-ronmental risk factors in northeast Alabama and examine temporal sequence and also ex-plore glioma incidence in other areas exposed to the same environmental pollutant(s) if a causal relationship is confirmed.

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