County-level characteristics associated with incidence, late-stage incidence, and mortality from screenable cancers

Background: Cancer screening differs by rurality and racial residential segregation, but the relationship between these county-level characteristics is understudied. Understanding this relationship and its implications for cancer outcomes could inform interventions to decrease cancer disparities. Methods: We linked county-level information from national data sources: 2008–2012 cancer incidence, late-stage incidence, and mortality rates (for breast, cervical, and colorectal cancer) from U.S. Cancer Statistics and the National Death Index; metropolitan status from U.S. Department of Agriculture; residential segregation derived from American Community Survey; and prevalence of cancer screening from National Cancer Institute's Small Area Estimates. We used multivariable, sparse Poisson generalized linear mixed models to assess cancer incidence, late-stage incidence, and mortality rates by county-level characteristics, controlling for density of physicians and median household income. Results: Cancer incidence, late-stage incidence, and mortality rates were 6–18% lower in metropolitan counties for breast and colorectal cancer, and 2–4% lower in more segregated counties for breast and colorectal cancer. Generally, reductions in cancer associated with residential segregation were limited to non-metropolitan counties. Cancer incidence, late-stage incidence, and mortality rates were associated with screening, with rates for corresponding cancers that were 2–9% higher in areas with more breast and colorectal screening, but 2–15% lower in areas with more cervical screening. Discussion: Lower cancer burden was observed in counties that were metropolitan and more segregated. Effect modification was observed by metropolitan status and county-level residential segregation, indicating that residential segregation may impact healthcare access differently in different county types. Additional studies are needed to inform interventions to reduce county-level disparities in cancer incidence, late-stage incidence, and mortality.

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Work Title County-level characteristics associated with incidence, late-stage incidence, and mortality from screenable cancers
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Open Access
Creators
  1. Jennifer L. Moss
  2. Ming Wang
  3. Menglu Liang
  4. Alain Kameni
  5. Kelsey C. Stoltzfus
  6. Tracy Onega
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. Cancer Epidemiology
Publication Date December 1, 2021
Publisher Identifier (DOI)
  1. https://doi.org/10.1016/j.canep.2021.102033
Deposited November 16, 2021

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  • Created
  • Added 2021_Moss_CancerEpi_county-inc-mort-screen-cancers.pdf
  • Added Creator Jennifer L. Moss
  • Added Creator Ming Wang
  • Added Creator Menglu Liang
  • Added Creator Alain Kameni
  • Added Creator Kelsey C. Stoltzfus
  • Added Creator Tracy Onega
  • Published
  • Updated
  • Updated
  • Updated