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Showing content from https://pubmed.ncbi.nlm.nih.gov/32150271/ below:

Association of Neighborhood Measures of Social Determinants of Health With Breast, Cervical, and Colorectal Cancer Screening Rates in the US Midwest

. 2020 Mar 2;3(3):e200618. doi: 10.1001/jamanetworkopen.2020.0618. Association of Neighborhood Measures of Social Determinants of Health With Breast, Cervical, and Colorectal Cancer Screening Rates in the US Midwest Rozalina G McCoy^{1 2 3}, Michelle A Lampman², Chyke A Doubeni^{4 5}, Lila J Finney Rutten^{1 2}, Jonathan W Inselman^{1 2}, Rachel E Giblon^{1 2}, Kari S Bunkers^{2 6}, Robert J Stroebel³, David Rushlow⁴, Sagar S Chawla⁶, Nilay D Shah^{1 2}

Affiliations

¹ Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
² Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
³ Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
⁴ Department of Family Medicine, Mayo Clinic, Rochester, Minnesota.
⁵ Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.
⁶ Department of Orthopaedics and Sports Medicine, University of Washington, Seattle.

PMID: 32150271
PMCID: PMC7063513
DOI: 10.1001/jamanetworkopen.2020.0618

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Association of Neighborhood Measures of Social Determinants of Health With Breast, Cervical, and Colorectal Cancer Screening Rates in the US Midwest

Shaheen S Kurani et al. JAMA Netw Open. 2020.

. 2020 Mar 2;3(3):e200618. doi: 10.1001/jamanetworkopen.2020.0618. Authors Shaheen S Kurani^{1 2}, Rozalina G McCoy^{1 2 3}, Michelle A Lampman², Chyke A Doubeni^{4 5}, Lila J Finney Rutten^{1 2}, Jonathan W Inselman^{1 2}, Rachel E Giblon^{1 2}, Kari S Bunkers^{2 6}, Robert J Stroebel³, David Rushlow⁴, Sagar S Chawla⁶, Nilay D Shah^{1 2} Affiliations

¹ Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
² Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
³ Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
⁴ Department of Family Medicine, Mayo Clinic, Rochester, Minnesota.
⁵ Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota.
⁶ Department of Orthopaedics and Sports Medicine, University of Washington, Seattle.

PMID: 32150271
PMCID: PMC7063513
DOI: 10.1001/jamanetworkopen.2020.0618

Item in Clipboard

Abstract

Importance: Despite advances in cancer treatment and cancer-related outcomes, disparities in cancer mortality remain. Lower rates of cancer prevention screening and consequent delays in diagnosis may exacerbate these disparities. Better understanding of the association between area-level social determinants of health and cancer screening may be helpful to increase screening rates.

Objective: To examine the association between area deprivation, rurality, and screening for breast, cervical, and colorectal cancer in patients from an integrated health care delivery system in 3 US Midwest states (Minnesota, Iowa, and Wisconsin).

Design, setting, and participants: In this cross-sectional study of adults receiving primary care at 75 primary care practices in Minnesota, Iowa, and Wisconsin, rates of recommended breast, cervical, and colorectal cancer screening completion were ascertained using electronic health records between July 1, 2016, and June 30, 2017. The area deprivation index (ADI) is a composite measure of social determinants of health composed of 17 US Census indicators and was calculated for all census block groups in Minnesota, Iowa, and Wisconsin (11 230 census block groups). Rurality was defined at the zip code level. Using multivariable logistic regression, this study examined the association between the ADI, rurality, and completion of cancer screening after adjusting for age, Charlson Comorbidity Index, race, and sex (for colorectal cancer only).

Main outcomes and measures: Completion of recommended breast, cervical, and colorectal cancer screening.

Results: The study cohorts were composed of 78 302 patients eligible for breast cancer screening (mean [SD] age, 61.8 [7.1] years), 126 731 patients eligible for cervical cancer screening (mean [SD] age, 42.6 [13.2] years), and 145 550 patients eligible for colorectal cancer screening (mean [SD] age, 62.4 [7.0] years; 52.9% [77 048 of 145 550] female). The odds of completing recommended screening were decreased for individuals living in the most deprived (highest ADI) census block group quintile compared with the least deprived (lowest ADI) quintile: the odds ratios were 0.51 (95% CI, 0.46-0.57) for breast cancer, 0.58 (95% CI, 0.54-0.62) for cervical cancer, and 0.57 (95% CI, 0.53-0.61) for colorectal cancer. Individuals living in rural areas compared with urban areas also had lower rates of cancer screening: the odds ratios were 0.76 (95% CI, 0.72-0.79) for breast cancer, 0.81 (95% CI, 0.79-0.83) for cervical cancer, and 0.93 (95% CI, 0.91-0.96) for colorectal cancer.

Conclusions and relevance: Individuals living in areas of greater deprivation and rurality had lower rates of recommended cancer screening, signaling the need for effective intervention strategies that may include improved community partnerships and patient engagement to enhance access to screening in highest-risk populations.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr McCoy reported receiving grants from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and AARP (formerly American Association of Retired Persons). Dr Doubeni reported being a member of the US Preventive Services Task Force (USPSTF) and authoring topics on colorectal cancer screening for UpToDate. Dr Shah reported received research support through the Mayo Clinic from the US Food and Drug Administration to establish the Yale–Mayo Clinic Center for Excellence in Regulatory Science and Innovation program; the Centers of Medicare and Medicaid Innovation under the Transforming Clinical Practice Initiative; the Agency for Healthcare Research and Quality ; the National Heart, Lung, and Blood Institute ; the National Science Foundation; and the Patient-Centered Outcomes Research Institute to develop a Clinical Data Research Network. No other disclosures were reported.

Figures
Figure.. Census Block Group–Level Hot Spot Analysis…

Figure.. Census Block Group–Level Hot Spot Analysis of 2016 Area Deprivation Indexes Across Minnesota, Iowa,…
Figure.. Census Block Group–Level Hot Spot Analysis of 2016 Area Deprivation Indexes Across Minnesota, Iowa, and Wisconsin

Hot spots (red) indicate spatial clusters of census block groups with greater deprivation, and cold spots (blue) indicate spatial clusters of census block groups with less deprivation. White areas represent areas without statistically significant clustering. Higher area deprivation indexes indicate greater deprivation. In the key, “% confidence” means the statistical significance with a 99%, 95%, or 90% confidence level.