Geographic disparities in cancer screening and fatalism among a nationally representative sample of US adults

Jennifer L. Moss, Rebecca Ehrenkranz, Lilian G. Perez, Brionna Y. Hair, Anne K. Julian

Research output: Contribution to journalArticle

Abstract

Background Cancer screening in the USA is suboptimal, particularly for individuals living in vulnerable communities. This study aimed to understand how rurality and racial segregation are independently and interactively associated with cancer screening and cancer fatalism. Methods We used data from a nationally representative sample of adults (n=17 736) from National Cancer Institute's Health Information National Trends Survey, 2011-2017, including cancer screening (colorectal, breast, cervical, prostate) among eligible participants and cancer fatalism. These data were linked to county-level metropolitan status/rurality (US Department of Agriculture) and racial segregation (US Census). We conducted multivariable analyses of associations of geographic variables with screening and fatalism. Results Breast cancer screening was lower in rural (92%, SE=1.5%) than urban counties (96%, SE=0.5%) (adjusted OR (aOR)=0.52, 95% CI 0.31 to 0.87). Colorectal cancer screening was higher in highly segregated (70%, SE=1.0%) than less segregated counties (65%, SE=1.7%) (aOR=1.28, 95% CI 1.04 to 1.58). Remaining outcomes did not vary by rurality or segregation, and these variables did not interact in their associations with screening or fatalism. Conclusion Similar to previous studies, breast cancer screening was less common in rural areas. Contrary to expectations, colorectal cancer screening was higher in highly segregated counties. More research is needed on the influence of geography on cancer screening and beliefs, and how access to facilities or information may mediate these relationships.

Original languageEnglish (US)
Pages (from-to)1128-1135
Number of pages8
JournalJournal of Epidemiology and Community Health
Volume73
Issue number12
DOIs
StatePublished - Dec 1 2019

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Early Detection of Cancer
Colorectal Neoplasms
Breast Neoplasms
United States Department of Agriculture
Architectural Accessibility
Geography
National Cancer Institute (U.S.)
National Institutes of Health (U.S.)
Censuses
Prostate
Neoplasms
Breast
Research

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Public Health, Environmental and Occupational Health

Cite this

Moss, Jennifer L. ; Ehrenkranz, Rebecca ; Perez, Lilian G. ; Hair, Brionna Y. ; Julian, Anne K. / Geographic disparities in cancer screening and fatalism among a nationally representative sample of US adults. In: Journal of Epidemiology and Community Health. 2019 ; Vol. 73, No. 12. pp. 1128-1135.
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abstract = "Background Cancer screening in the USA is suboptimal, particularly for individuals living in vulnerable communities. This study aimed to understand how rurality and racial segregation are independently and interactively associated with cancer screening and cancer fatalism. Methods We used data from a nationally representative sample of adults (n=17 736) from National Cancer Institute's Health Information National Trends Survey, 2011-2017, including cancer screening (colorectal, breast, cervical, prostate) among eligible participants and cancer fatalism. These data were linked to county-level metropolitan status/rurality (US Department of Agriculture) and racial segregation (US Census). We conducted multivariable analyses of associations of geographic variables with screening and fatalism. Results Breast cancer screening was lower in rural (92{\%}, SE=1.5{\%}) than urban counties (96{\%}, SE=0.5{\%}) (adjusted OR (aOR)=0.52, 95{\%} CI 0.31 to 0.87). Colorectal cancer screening was higher in highly segregated (70{\%}, SE=1.0{\%}) than less segregated counties (65{\%}, SE=1.7{\%}) (aOR=1.28, 95{\%} CI 1.04 to 1.58). Remaining outcomes did not vary by rurality or segregation, and these variables did not interact in their associations with screening or fatalism. Conclusion Similar to previous studies, breast cancer screening was less common in rural areas. Contrary to expectations, colorectal cancer screening was higher in highly segregated counties. More research is needed on the influence of geography on cancer screening and beliefs, and how access to facilities or information may mediate these relationships.",
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Geographic disparities in cancer screening and fatalism among a nationally representative sample of US adults. / Moss, Jennifer L.; Ehrenkranz, Rebecca; Perez, Lilian G.; Hair, Brionna Y.; Julian, Anne K.

In: Journal of Epidemiology and Community Health, Vol. 73, No. 12, 01.12.2019, p. 1128-1135.

Research output: Contribution to journalArticle

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T1 - Geographic disparities in cancer screening and fatalism among a nationally representative sample of US adults

AU - Moss, Jennifer L.

AU - Ehrenkranz, Rebecca

AU - Perez, Lilian G.

AU - Hair, Brionna Y.

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N2 - Background Cancer screening in the USA is suboptimal, particularly for individuals living in vulnerable communities. This study aimed to understand how rurality and racial segregation are independently and interactively associated with cancer screening and cancer fatalism. Methods We used data from a nationally representative sample of adults (n=17 736) from National Cancer Institute's Health Information National Trends Survey, 2011-2017, including cancer screening (colorectal, breast, cervical, prostate) among eligible participants and cancer fatalism. These data were linked to county-level metropolitan status/rurality (US Department of Agriculture) and racial segregation (US Census). We conducted multivariable analyses of associations of geographic variables with screening and fatalism. Results Breast cancer screening was lower in rural (92%, SE=1.5%) than urban counties (96%, SE=0.5%) (adjusted OR (aOR)=0.52, 95% CI 0.31 to 0.87). Colorectal cancer screening was higher in highly segregated (70%, SE=1.0%) than less segregated counties (65%, SE=1.7%) (aOR=1.28, 95% CI 1.04 to 1.58). Remaining outcomes did not vary by rurality or segregation, and these variables did not interact in their associations with screening or fatalism. Conclusion Similar to previous studies, breast cancer screening was less common in rural areas. Contrary to expectations, colorectal cancer screening was higher in highly segregated counties. More research is needed on the influence of geography on cancer screening and beliefs, and how access to facilities or information may mediate these relationships.

AB - Background Cancer screening in the USA is suboptimal, particularly for individuals living in vulnerable communities. This study aimed to understand how rurality and racial segregation are independently and interactively associated with cancer screening and cancer fatalism. Methods We used data from a nationally representative sample of adults (n=17 736) from National Cancer Institute's Health Information National Trends Survey, 2011-2017, including cancer screening (colorectal, breast, cervical, prostate) among eligible participants and cancer fatalism. These data were linked to county-level metropolitan status/rurality (US Department of Agriculture) and racial segregation (US Census). We conducted multivariable analyses of associations of geographic variables with screening and fatalism. Results Breast cancer screening was lower in rural (92%, SE=1.5%) than urban counties (96%, SE=0.5%) (adjusted OR (aOR)=0.52, 95% CI 0.31 to 0.87). Colorectal cancer screening was higher in highly segregated (70%, SE=1.0%) than less segregated counties (65%, SE=1.7%) (aOR=1.28, 95% CI 1.04 to 1.58). Remaining outcomes did not vary by rurality or segregation, and these variables did not interact in their associations with screening or fatalism. Conclusion Similar to previous studies, breast cancer screening was less common in rural areas. Contrary to expectations, colorectal cancer screening was higher in highly segregated counties. More research is needed on the influence of geography on cancer screening and beliefs, and how access to facilities or information may mediate these relationships.

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