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

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 arealevel 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.

Determinants of Participation and Detection Rate of Colorectal Cancer From a Population-Based Screening Program in China

“…With the increase of age, the detection rate of advanced neoplasms, non-advanced adenomas, and any neoplasms increased both for males and females, suggesting that CRC screening is more effective in the elderly population (23). However, the detection rate in the 70-74 age group decreased significantly, which is inconsistent with the trend of CRC in China (24). We noticed that the 70-74 age group had the lowest compliance with colonoscopy (12.30%), and compliance may be an important reason for restricting the detection rate (25).…”

Racial and Ethnic Disparities in COVID-19: Evidence from Six Large Cities

“…Our inability to explain most of the disparities in COVID-19 spread is perhaps surprising since we control for the risk factors largely associated with social deprivation. Recent studies have used area deprivation indexes (ADI) to explain disparities in avoidable hospitalizations and readmissions (Kind and Buckingham 2018;Jencks et al 2019;Hu et al 2018) and difficulty managing chronic illnesses (Kurani et al 2020;Zhang et al 2020;Camacho et al 2017;Durfey et al 2019). ADIs are composite measures generally made up of weighted combinations of education, labor market composition, income, income inequality, and housing market information such as home ownership (Singh 2003).…”

Racial and Ethnic Disparities in COVID-19: Evidence from Six Large Cities

“…Our inability to explain most of the disparities in COVID-19 spread is perhaps surprising since we control for the risk factors largely associated with social deprivation. Recent studies have used area deprivation indexes (ADI) to explain disparities in avoidable hospitalizations and readmissions (Kind, Buckingham 2018;Jencks et al 2019;Hu et al 2018) and difficulty managing chronic illnesses (Kurani et al 2020;Zhang et al 2020;Camacho et al 2017;Durfey et al 2019). ADIs are composite measures generally made up of weighted combinations of education, labor market composition, income, income inequality, and housing market information such as home ownership (Singh 2003 (Poteat et al 2020;Braveman, Gottlieb 2014).…”