Abstract PO-258: Cancer risk factors and screening across various U.S. rural classification codes: Cancer disparities in the context of rurality
Authors: Hirko Kelly A. , Xu Huiwen , Rogers Laura Q. , Martin Michelle Y. , Roy Siddhartha , Kelly Kimberly M. , Christy Shannon M. , Ashing Kimlin T. , Yi Jean C. , Lewis-Thames Marquita W. , Meade Cathy D. , Lu Qian , Gwede Clement K. , Nemeth Julianna , Ceballos Rachel M. , Menon Usha , Cueva Katie , Yeary Karen , Klesges Lisa , Baskin Monica L. , Alcaraz Kassandra I. , Ford Sabrina 
Published: December 2020

Abstract
Incidence and mortality of many preventable cancers are higher in rural compared to urban U.S. regions. However, prior research is limited by methodological inconsistencies in defining rurality, and has largely focused on a rural-urban dichotomy which ignores potential variability of cancer risk factors and outcomes within rural and urban settings. These limitations hamper data interpretation and may lead to inequitable distribution of resources to address disparities. In this study, we describe cancer risk factors and screening across various U.S. rural-urban classification codes to inform our understanding of cancer disparities across the rural to urban continuum. We examined the prevalence and trends in cancer risk factors and screening across the following rural-urban classification codes for counties and county-equivalents in 2013; U.S. Office of Management and Budget (OMB), National Center for Health Statistics (NCHS), U.S. Department of Agriculture, Economic Research Service’s rural-urban continuum codes (RUCC), and Urban Influence Codes (UIC). County-level data on demographics (age, race, education, income, poverty level, insurance status), and cancer risk factors (obesity, physical inactivity, alcohol consumption), including cancer screening (colorectal, cervical and breast) were obtained from the U.S. Census Bureau, Behavioral Risk Factor Surveillance System, and National Health Interview Survey from 2008-2013. Overall, rural counties’ populations were more likely to be older, white, and uninsured with lower educational attainment and household income than urban counties (all ptrend&lt;0.001). Across all classification codes, the prevalence of smoking, obesity, physical inactivity, and binge alcohol use increased (all ptrend&lt;0.03), while colorectal, cervical and breast cancer screening decreased (all ptrend&lt;0.001) with increasing rurality. Variation in the prevalence of cancer risk factors and screening was also evident within rural regions. For example, cervical cancer screening ranged from 67.6% to 74.7%, breast cancer screening from 65.4% to 68.2%, and colorectal cancer screening from 52.8% to 57.2% across rural counties. Our findings suggest that rural cancer disparities persist across multiple rural-urban classification codes, with marked variation in cancer risk factors and screening apparent within rural regions. Thus, focusing on a rural-urban dichotomy may fail to identify subpopulations of rural residents at greater risk for cancer and cancer-related mortality. As such, the variation in cancer disparities within rural regions, including persistent racial/ethnic and socioeconomic differences, should be considered in future cancer control research to inform the development of targeted policies and strategies to address rural cancer disparities.
Citation Format: Kelly A. Hirko, Huiwen Xu, Laura Q. Rogers, Michelle Y. Martin, Siddhartha Roy, Kimberly M. Kelly, Shannon M. Christy, Kimlin T. Ashing, Jean C. Yi, Marquita W. Lewis-Thames, Cathy D. Meade, Qian Lu, Clement K. Gwede, Julianna Nemeth, Rachel M. Ceballos, Usha Menon, Katie Cueva, Karen Yeary, Lisa Klesges, Monica L. Baskin, Kassandra I. Alcaraz, Sabrina Ford. Cancer risk factors and screening across various U.S. rural classification codes: Cancer disparities in the context of rurality [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-258.