Cancer disparities in the context of rurality: risk factors and screening across various U.S. rural classification codes

Kelly A. Hirko; Huiwen Xu; Laura Q. Rogers; Michelle Y. Martin; Siddhartha Roy; Kimberly M. Kelly; Shannon M. Christy; Kimlin Tam Ashing; Jean C. Yi; Marquita W. Lewis-Thames; Cathy D. Meade; Qian Lu; Clement K. Gwede; Julianna Nemeth; Rachel M. Ceballos; Usha Menon; Katie Cueva; Karen Yeary; Lisa M. Klesges; Monica L. Baskin; Kassandra I. Alcaraz; Sabrina Ford

doi:10.1007/s10552-022-01599-2

Cancer disparities in the context of rurality: risk factors and screening across various U.S. rural classification codes

Kelly A. Hirko^*, Huiwen Xu, Laura Q. Rogers, Michelle Y. Martin, Siddhartha Roy, Kimberly M. Kelly, Shannon M. Christy, Kimlin Tam Ashing, Jean C. Yi, Marquita W. Lewis-Thames, Cathy D. Meade, Qian Lu, Clement K. Gwede, Julianna Nemeth, Rachel M. Ceballos, Usha Menon, Katie Cueva, Karen Yeary, Lisa M. Klesges, Monica L. BaskinKassandra I. Alcaraz, Sabrina Ford

^*Corresponding author for this work

Medical Social Sciences

Research output: Contribution to journal › Article › peer-review

18 Scopus citations

Abstract

Purpose: Prior cancer research is limited by inconsistencies in defining rurality. The purpose of this study was to describe the prevalence of cancer risk factors and cancer screening behaviors across various county-based rural classification codes, including measures reflecting a continuum, to inform our understanding of cancer disparities according to the extent of rurality. Methods: Using an ecological cross-sectional design, we examined differences in cancer risk factors and cancer screening behaviors from the Behavioral Risk Factor Surveillance System and National Health Interview Survey (2008–2013) across rural counties and between rural and urban counties using four rural–urban classification codes for counties and county-equivalents in 2013: U.S. Office of Management and Budget, National Center for Health Statistics, USDA Economic Research Service’s rural–urban continuum codes, and Urban Influence Codes. Results: Although a rural-to-urban gradient was not consistently evident across all classification codes, the prevalence of smoking, obesity, physical inactivity, and binge alcohol use increased (all p_trend < 0.03), while colorectal, cervical and breast cancer screening decreased (all p_trend < 0.001) with increasing rurality. Differences in the prevalence of risk factors and screening behaviors across rural areas were greater than differences between rural and urban counties for obesity (2.4% vs. 1.5%), physical activity (2.9% vs. 2.5%), binge alcohol use (3.4% vs. 0.4%), cervical cancer screening (6.8% vs. 4.0%), and colorectal cancer screening (4.4% vs. 3.8%). Conclusions: Rural cancer disparities persist across multiple rural–urban classification codes, with marked variation in cancer risk factors and screening evident within rural regions. Focusing only on a rural–urban dichotomy may not sufficiently capture subpopulations of rural residents at greater risk for cancer and cancer-related mortality.

Original language	English (US)
Pages (from-to)	1095-1105
Number of pages	11
Journal	Cancer Causes and Control
Volume	33
Issue number	8
DOIs	https://doi.org/10.1007/s10552-022-01599-2
State	Published - Aug 2022

Funding

No funding was received to assist with the preparation of this manuscript. Dr. Nemeth is funded by NCI career development grant 1K07CA216321-01A1. The authors assume full responsibility for analyses and interpretation of these data. Dr. Nemeth is funded by National Cancer Institute career development grant 1K07CA216321-01A1.

Keywords

Alcohol
Cancer screening
Health disparities
Obesity
Physical activity
Risk factors
Rural
Smoking

ASJC Scopus subject areas

Oncology
Cancer Research

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s10552-022-01599-2

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Hirko, K. A., Xu, H., Rogers, L. Q., Martin, M. Y., Roy, S., Kelly, K. M., Christy, S. M., Ashing, K. T., Yi, J. C., Lewis-Thames, M. W., Meade, C. D., Lu, Q., Gwede, C. K., Nemeth, J., Ceballos, R. M., Menon, U., Cueva, K., Yeary, K., Klesges, L. M., ... Ford, S. (2022). Cancer disparities in the context of rurality: risk factors and screening across various U.S. rural classification codes. Cancer Causes and Control, 33(8), 1095-1105. https://doi.org/10.1007/s10552-022-01599-2

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title = "Cancer disparities in the context of rurality: risk factors and screening across various U.S. rural classification codes",

abstract = "Purpose: Prior cancer research is limited by inconsistencies in defining rurality. The purpose of this study was to describe the prevalence of cancer risk factors and cancer screening behaviors across various county-based rural classification codes, including measures reflecting a continuum, to inform our understanding of cancer disparities according to the extent of rurality. Methods: Using an ecological cross-sectional design, we examined differences in cancer risk factors and cancer screening behaviors from the Behavioral Risk Factor Surveillance System and National Health Interview Survey (2008–2013) across rural counties and between rural and urban counties using four rural–urban classification codes for counties and county-equivalents in 2013: U.S. Office of Management and Budget, National Center for Health Statistics, USDA Economic Research Service{\textquoteright}s rural–urban continuum codes, and Urban Influence Codes. Results: Although a rural-to-urban gradient was not consistently evident across all classification codes, the prevalence of smoking, obesity, physical inactivity, and binge alcohol use increased (all ptrend < 0.03), while colorectal, cervical and breast cancer screening decreased (all ptrend < 0.001) with increasing rurality. Differences in the prevalence of risk factors and screening behaviors across rural areas were greater than differences between rural and urban counties for obesity (2.4% vs. 1.5%), physical activity (2.9% vs. 2.5%), binge alcohol use (3.4% vs. 0.4%), cervical cancer screening (6.8% vs. 4.0%), and colorectal cancer screening (4.4% vs. 3.8%). Conclusions: Rural cancer disparities persist across multiple rural–urban classification codes, with marked variation in cancer risk factors and screening evident within rural regions. Focusing only on a rural–urban dichotomy may not sufficiently capture subpopulations of rural residents at greater risk for cancer and cancer-related mortality.",

keywords = "Alcohol, Cancer screening, Health disparities, Obesity, Physical activity, Risk factors, Rural, Smoking",

author = "Hirko, {Kelly A.} and Huiwen Xu and Rogers, {Laura Q.} and Martin, {Michelle Y.} and Siddhartha Roy and Kelly, {Kimberly M.} and Christy, {Shannon M.} and Ashing, {Kimlin Tam} and Yi, {Jean C.} and Lewis-Thames, {Marquita W.} and Meade, {Cathy D.} and Qian Lu and Gwede, {Clement K.} and Julianna Nemeth and Ceballos, {Rachel M.} and Usha Menon and Katie Cueva and Karen Yeary and Klesges, {Lisa M.} and Baskin, {Monica L.} and Alcaraz, {Kassandra I.} and Sabrina Ford",

note = "Publisher Copyright: {\textcopyright} 2022, The Author(s), under exclusive licence to Springer Nature Switzerland AG.",

year = "2022",

month = aug,

doi = "10.1007/s10552-022-01599-2",

language = "English (US)",

volume = "33",

pages = "1095--1105",

journal = "Cancer Causes and Control",

issn = "0957-5243",

publisher = "Springer Netherlands",

number = "8",

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Hirko, KA, Xu, H, Rogers, LQ, Martin, MY, Roy, S, Kelly, KM, Christy, SM, Ashing, KT, Yi, JC, Lewis-Thames, MW, Meade, CD, Lu, Q, Gwede, CK, Nemeth, J, Ceballos, RM, Menon, U, Cueva, K, Yeary, K, Klesges, LM, Baskin, ML, Alcaraz, KI & Ford, S 2022, 'Cancer disparities in the context of rurality: risk factors and screening across various U.S. rural classification codes', Cancer Causes and Control, vol. 33, no. 8, pp. 1095-1105. https://doi.org/10.1007/s10552-022-01599-2

TY - JOUR

T1 - Cancer disparities in the context of rurality

T2 - risk factors and screening across various U.S. rural classification codes

AU - Hirko, Kelly A.

AU - Xu, Huiwen

AU - Rogers, Laura Q.

AU - Martin, Michelle Y.

AU - Roy, Siddhartha

AU - Kelly, Kimberly M.

AU - Christy, Shannon M.

AU - Ashing, Kimlin Tam

AU - Yi, Jean C.

AU - Lewis-Thames, Marquita W.

AU - Meade, Cathy D.

AU - Lu, Qian

AU - Gwede, Clement K.

AU - Nemeth, Julianna

AU - Ceballos, Rachel M.

AU - Menon, Usha

AU - Cueva, Katie

AU - Yeary, Karen

AU - Klesges, Lisa M.

AU - Baskin, Monica L.

AU - Alcaraz, Kassandra I.

AU - Ford, Sabrina

PY - 2022/8

Y1 - 2022/8

N2 - Purpose: Prior cancer research is limited by inconsistencies in defining rurality. The purpose of this study was to describe the prevalence of cancer risk factors and cancer screening behaviors across various county-based rural classification codes, including measures reflecting a continuum, to inform our understanding of cancer disparities according to the extent of rurality. Methods: Using an ecological cross-sectional design, we examined differences in cancer risk factors and cancer screening behaviors from the Behavioral Risk Factor Surveillance System and National Health Interview Survey (2008–2013) across rural counties and between rural and urban counties using four rural–urban classification codes for counties and county-equivalents in 2013: U.S. Office of Management and Budget, National Center for Health Statistics, USDA Economic Research Service’s rural–urban continuum codes, and Urban Influence Codes. Results: Although a rural-to-urban gradient was not consistently evident across all classification codes, the prevalence of smoking, obesity, physical inactivity, and binge alcohol use increased (all ptrend < 0.03), while colorectal, cervical and breast cancer screening decreased (all ptrend < 0.001) with increasing rurality. Differences in the prevalence of risk factors and screening behaviors across rural areas were greater than differences between rural and urban counties for obesity (2.4% vs. 1.5%), physical activity (2.9% vs. 2.5%), binge alcohol use (3.4% vs. 0.4%), cervical cancer screening (6.8% vs. 4.0%), and colorectal cancer screening (4.4% vs. 3.8%). Conclusions: Rural cancer disparities persist across multiple rural–urban classification codes, with marked variation in cancer risk factors and screening evident within rural regions. Focusing only on a rural–urban dichotomy may not sufficiently capture subpopulations of rural residents at greater risk for cancer and cancer-related mortality.

AB - Purpose: Prior cancer research is limited by inconsistencies in defining rurality. The purpose of this study was to describe the prevalence of cancer risk factors and cancer screening behaviors across various county-based rural classification codes, including measures reflecting a continuum, to inform our understanding of cancer disparities according to the extent of rurality. Methods: Using an ecological cross-sectional design, we examined differences in cancer risk factors and cancer screening behaviors from the Behavioral Risk Factor Surveillance System and National Health Interview Survey (2008–2013) across rural counties and between rural and urban counties using four rural–urban classification codes for counties and county-equivalents in 2013: U.S. Office of Management and Budget, National Center for Health Statistics, USDA Economic Research Service’s rural–urban continuum codes, and Urban Influence Codes. Results: Although a rural-to-urban gradient was not consistently evident across all classification codes, the prevalence of smoking, obesity, physical inactivity, and binge alcohol use increased (all ptrend < 0.03), while colorectal, cervical and breast cancer screening decreased (all ptrend < 0.001) with increasing rurality. Differences in the prevalence of risk factors and screening behaviors across rural areas were greater than differences between rural and urban counties for obesity (2.4% vs. 1.5%), physical activity (2.9% vs. 2.5%), binge alcohol use (3.4% vs. 0.4%), cervical cancer screening (6.8% vs. 4.0%), and colorectal cancer screening (4.4% vs. 3.8%). Conclusions: Rural cancer disparities persist across multiple rural–urban classification codes, with marked variation in cancer risk factors and screening evident within rural regions. Focusing only on a rural–urban dichotomy may not sufficiently capture subpopulations of rural residents at greater risk for cancer and cancer-related mortality.

KW - Alcohol

KW - Cancer screening

KW - Health disparities

KW - Obesity

KW - Physical activity

KW - Risk factors

KW - Rural

KW - Smoking

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Cancer disparities in the context of rurality: risk factors and screening across various U.S. rural classification codes

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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