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

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.

authors

Moss JL,Ehrenkranz R,Perez LG,Hair BY,Julian AK

doi

10.1136/jech-2019-212425

subject

Has Abstract

pub_date

2019-12-01 00:00:00

pages

1128-1135

issue

12

eissn

0143-005X

issn

1470-2738

pii

jech-2019-212425

journal_volume

73

pub_type

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