Abstract A117: Area deprivation index and rurality in relation to lung cancer prevalence and mortality in a rural state
Authors: Fairfield Kathleen M , Black Adam , Ziller Erika , Murray Kimberly , Lucas Lee , Waterston Leo B , Korsen Neil , Ineza Darlene , Han Paul KJ 
Published: September 2020

Abstract
Objectives: Lung cancer is the leading cause of cancer-related mortality. In rural areas, socioeconomic deprivation and geographic barriers to care may both influence lung cancer prevalence and outcomes. We sought to describe how socioeconomic deprivation and rurality are related to lung cancer prevalence and mortality. Methods: We conducted a population-based cross-sectional analysis of: 1) prevalent lung cancers identified in a statewide all-payer claims dataset between 2012 and 2016; 2) lung cancer deaths in Maine from 2012-2016, ascertained by the state death registry; 3) rurality; and 4) area deprivation index (ADI), a geographic area-based measure of socioeconomic deprivation. Analyses examined rate ratios for lung cancer prevalence and mortality according to rurality (small/isolated rural, large rural, or urban) and ADI (in quintiles, with highest reflecting the most deprivation) and after adjusting for age, sex, and area-level smoking rates as determined by Behavioral Risk Factor Surveillance System data. Results: Among 1,223,006 adults aged 20+ in the all-payer claims dataset during the 5-year observation period, 8300 received care for prevalent lung cancer and there were 4618 deaths from lung cancer between 2012 and 2016. Of the prevalent lung cancer cases, 36.1% resided in isolated or small rural areas, and 42.6% resided in the highest two quintiles for ADI. Increasing rurality was positively associated with lung cancer prevalence and mortality, but these associations did not persist after adjusting for age, sex and smoking rates. However, increasing ADI was positively associated with both lung cancer prevalence (rate ratio 1.41 (95% CI 1.30-1.54) for ADI quintile 5 vs. quintile 1) and mortality (rate ratio for ADI quintile 5 vs. quintile 1, 1.59 (95% CI 1.41-1.79) in multivariable models adjusted for age, sex, and smoking rates. Conclusion: Socioeconomic deprivation was associated with higher lung cancer prevalence and mortality, but rurality was not. These findings suggest that interventions aimed at improving access to lung cancer prevention, screening, and treatment services should target populations with socioeconomic deprivation, rather than rurality per se. Future research should examine the relationship between socioeconomic deprivation and other indicators of population health in rural areas.
Citation Format: Kathleen M Fairfield, Adam Black, Erika Ziller, Kimberly Murray, Lee Lucas, Leo B Waterston, Neil Korsen, Darlene Ineza, Paul KJ Han. Area deprivation index and rurality in relation to lung cancer prevalence and mortality in a rural state [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A117.