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Geographic cancer screening disparities in US linked to county vulnerability scores

by John R. Fischer, Senior Reporter | September 30, 2022
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Geographic cancer screening disparities are linked to county vulnerability index scores.
Residents living in U.S. counties deemed more vulnerable than others were less likely to receive timely screenings for breast, cervical and colorectal cancer.

Socioeconomic status and racial and ethnic minority status, along with other factors, determine a county’s social vulnerability index (SVI), which uses census data to determine how vulnerable a county or regional area is. Those with high SVIs had lower screening rates, according to a population-based, cross-sectional study by researchers at UTHealth Houston.

Across 3,141 U.S. counties, regional disparities in screenings, from lowest- to highest-performing counties, were 54% to 81.8% for breast; 69.9% to 89.7% for cervical; and 39.8% to 74.4% for colorectal.

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"There are various types of community-based screening programs out there to address these disparities. Our study supports these public health initiatives and further emphasizes the importance of data-driven strategies for targeting the significantly needed areas and tailoring programs according to the area-level factors," Ryan Suk, Ph.D., assistant professor of management, policy and community health at UTHealth School of Public Health, told HCB News.

Suk co-led the study with Cici Bauer, Ph.D., associate professor of biostatistics and data science, also from UTHealth School of Public Health.

Using county-level information from the Centers for Disease Control and Prevention’s PLACES and SVI data sets from 2018, they found that in the most vulnerable counties (the highest fifth), people were 14% less likely to have been screened for breast; 20% less likely for cervical; and 28% less likely for colorectal than the least vulnerable (the lowest fifth).

All three cancer screening rates in general were higher in eastern and western counties and lower in southern ones.

While rural and urban status and healthcare access correlate with cancer screening rates, they did not explain the geographic disparities in screenings or change the association between social vulnerability and screenings.

Suk says that some populations have very low uptake, while in others, the cancer screening rate is higher than the national target rate. She says that it is especially important to spread awareness about colorectal cancer screenings across different geographies in a broader way, as it has the lowest rates throughout the U.S., compared to breast and cervical cancer.

"Other risk factors of cancer itself might be also associated with environmental differences across different geographic areas (e.g., areas with more exposure to sunlight, etc.). However, adequate cancer "screening uptake" is mainly associated with social determinants of health, and that is where our study focuses," she said.

The analyses were conducted in October 2021 to February 2022.

The findings were published in Jama Network Open.

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