Urban/Rural Differences in Breast and Cervical Cancer Incidence: The Mediating Roles of Socioeconomic Status and Provider Density

Abstract

Background Breast and cervical cancer incidence vary by urbanicity, and several ecological factors could contribute to these patterns. In particular, cancer screening or other sociodemographic and healthcare system variables could explain geographic disparities in cancer incidence. Methods Governmental and research sources provided data on 612 counties in the Surveillance, Epidemiology, and End Results program for rural-urban continuum code, socioeconomic status (SES) quintile, percent non-Hispanic white residents, density of primary care physicians, cancer screening, and breast and cervical cancer incidence rates (2009–2013). Ecological mediation analyses used weighted least squares regression to examine whether candidate mediators explained the relationship between urbanicity and cancer incidence. Results As urbanicity increased, so did breast cancer incidence (β̂=0.23, p<.001). SES quintile and density of primary care physicians mediated this relationship, while percent non-Hispanic white suppressed it (all p<.05); county-level mammography levels did not contribute to the relationship. After controlling for these variables, urbanicity and breast cancer incidence were no longer associated (β̂=0.11, p>.05). In contrast, as urbanicity increased, cervical cancer incidence decreased (β̂=−0.33, p<.001). SES quintile and density of primary care physicians mediated this relationship (both p<.05); percent non-Hispanic white and Pap screening levels did not contribute to the relationship. After controlling for these variables, the relationship between urbanicity and cervical cancer incidence was still statistically significant (β̂=−0.13, p<.05). Conclusions County-level SES and density of primary care physicians explained the relationships between urbanicity and breast and cervical cancer incidence. Improving these factors in more rural counties could ameliorate geographic disparities in breast and cervical cancer incidence.

Inequalities in breast cancer incidence and stage distribution between urban and rural female population in Świętokrzyskie Province, Poland

“…Improved health care access and density of primary care physicians in the urban population may explain the urbanrural inequalities in breast cancer incidence [34]. In the Świętokrzyskie Province an increase in the incidence of breast cancer was observed in both groups of patients: urban and rural women.…”

Trends of mortality due to breast cancer in Poland, 2000–2016

“…Studies conducted in 1995-2013 in North America showed a similar relationship. Incidence rates, calculated in the analysed period, were higher in urban areas than in rural areas [35,36]. Reasons for these differences include: increased exposure to carcinogenic factors in cities, different city lifestyle, as well as higher fertility rates in women inhabiting rural areas, which reduces the risk of the disease.…”

Patterns of breast, prostate and cervical cancer incidence and mortality in Colombia: An administrative registry data analysis

“…On the other hand, the incidence pattern for cervical cancer was different, showing a signi cantly higher ASR in "other departments" region, mainly composed of nonmetropolitan and rural areas. It has been reported that women in rural areas may experience barriers to optimal cervical cancer prevention, screening, and treatment, as well as, a higher frequency of risky sexual behaviors (23,24).…”