Abstract 797: Area deprivation, rurality, healthcare utilization, quality of life, and health status among cancer patients
Authors: Lee Hyunjung , Lee Dongjun , Ng Ding Quan , Wiese Daniel , Jemal Ahmedin , Islami Farhad 
Published: March 2024

Background: Living in deprived or rural neighborhoods can negatively influence individual health through various mechanisms, including limited access to care due to scarce resources, medical facilities, or health professionals. Prior ecological studies have shown an association between living in rural or disadvantaged areas and higher cancer morbidity or mortality, but research on the association between neighborhood of residence and cancer patients’ healthcare utilization, health status, or quality of life has been limited.

Method: We used survey and electronic health records data on cancer patients aged ≥18 years (N=16,606) from All of US Controlled Tier Dataset v7 (summer 2017-July 1, 2022). Area deprivation index (ADI) was based on six items, including 3-digit zip code-level median household income, proportions of high school graduation, vacant housing, recipients of public assistance income, and individual without health insurance or with incomes below the poverty level. Rural-urban status was defined at the 3-digit zip code-level as urban (100% urban), mostly urban (≥50%-&lt;100% urban), and rural (&gt;50% rural). Logistic regression models were used to estimate the association between ADI or rurality and health care utilization (general doctor, specialist, mental health, or nurse practitioner/physical assistant [NP/PA] visits) or health outcome (fair/poor physical and mental health status, quality of life), controlling for various covariates.

Results: Cancer patients living in the most deprived areas (ADI 5th quintile) were less likely to have general doctor visits (OR=0.73; 95% CI=0.54-0.85), NA/PA visits (OR=0.87; 95% CI=0.77-0.99), or mental health professional visits (OR=0.85; 95% CI=0.74-0.98), and more likely to have fair or poor quality of life (OR=1.31; 95% CI=1.06-1.62), compared to those living in the least deprived areas (ADI 1st quintile), controlling for all covariates. Similarly, rural cancer patients were less likely to have general doctor visits (OR=0.58; 95% CI=0.42-0.79) or mental health professional visits (OR=0.53; 95% CI=0.41-0.67), and more likely to have fair/poor physical health (OR=1.27; 95% CI=1.03-1.57), compared with urban cancer patients. However, rural cancer patients were more likely to have NA/PA visits (OR=1.29; 95% CI=1.04-1.58) and less likely to have fair/poor mental health (OR=0.66; 95% CI=0.48-0.92). Cancer patients in mostly urban areas showed similar patterns to those in rural areas but the magnitudes of associations were smaller.

Conclusions: In this study, cancer patients living in deprived or rural areas were less likely to have general doctor or mental health professional visits and more likely to have poor physical health compared to patients in the least deprived or urban area. Community-level interventions in deprived or rural areas are required to mitigate disparities in healthcare and health among cancer patients.

Citation Format: Hyunjung Lee, Dongjun Lee, Ding Quan Ng, Daniel Wiese, Ahmedin Jemal, Farhad Islami. Area deprivation, rurality, healthcare utilization, quality of life, and health status among cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 797.