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. 2022 Aug;33(8):1095-1105.
doi: 10.1007/s10552-022-01599-2. Epub 2022 Jun 30.

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

Kelly A Hirko  1 , Huiwen Xu  2 , Laura Q Rogers  3 , Michelle Y Martin  4 , Siddhartha Roy  5 , Kimberly M Kelly  6 , Shannon M Christy  7 , Kimlin Tam Ashing  8 , Jean C Yi  9 , Marquita W Lewis-Thames  10 , Cathy D Meade  7 , Qian Lu  11 , Clement K Gwede  7 , Julianna Nemeth  12 , Rachel M Ceballos  13 , Usha Menon  14 , Katie Cueva  15 , Karen Yeary  16 , Lisa M Klesges  17 , Monica L Baskin  3 , Kassandra I Alcaraz  18 , Sabrina Ford  19
Affiliations

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

Kelly A Hirko et al. Cancer Causes Control. 2022 Aug.

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 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.

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Conflict of interest statement

Compliance with Ethical Standards

The authors declare no potential conflicts of interest

Figures

Figure 1a:
Figure 1a:
Differences in county-level cancer risk factors among U.S. adults between rural and urban counties and across rural counties OMB=U.S. Office of Management and Budget codes, NCHS=National Center for Health Statistics, RUCC=USDA Economic Research Service’s rural-urban continuum codes, UIC=Urban Influence Codes
Figure 1b:
Figure 1b:
Differences in county-level cancer screening among U.S. adults between rural and urban counties and across rural counties OMB=U.S. Office of Management and Budget codes, NCHS=National Center for Health Statistics, RUCC=USDA Economic Research Service’s rural-urban continuum codes, UIC=Urban Influence Codes
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