Abstract A062: Intersectionality in cancer health disparities: Rurality, socioeconomic factors, and health resources
Authors: Zhu Xi , Kahl Amanda R , Charlton Mary E 
Published: September 2020

Abstract
Purpose: Cancer health disparities are results of complex, intersectional effects of many factors that shape people’s exposure and response to disease risks and patterns of health service utilization. We examined the cancer incidence and mortality rates in different types of rural places that were classified based on relevant population and health-resource characteristics. Methods: We developed a taxonomy of rural places using the most recent census, American Hospital Association Survey, Nursing Home Compare, and National Provider Identifier data. Cluster analysis was used to empirically classify US nonmetropolitan counties into distinct types of places based on both population characteristics (race/ethnicity, poverty, unemployment rate, health insurance status, and age distribution) and health resources (numbers of primary care physicians, specialists, other providers, staffed hospital beds, skilled nursing facility beds, and average daily census per capita). Surveillance, Epidemiology, and End Results data from 18 cancer registries were used to analyze the differences in 2000-2016 age-adjusted incidence rate (AAIR), late-stage incidence rate, and mortality rate (AAMR) for all cancers and behavior-related cancers (e.g., cancers associated with alcohol use, tobacco use, HPV, physical activity) between urban and different types of rural counties. Principal Findings: Four distinct types of rural places were identified based on four intersecting factors: economic and racial factor, age distribution, healthcare provider resources, and healthcare facility resources. The four types of rural counties included: Type 1 with lower economic resources and more racial/ethnic minority; Type 2 with younger population, higher economic resources, and fewer racial/ethnic minority; Type 3 with older population; and Type 4 with higher healthcare provider and facility resources. Type 1 rural counties had a lower all cancer AAIR (448.7 per 100,000) than urban and other types of rural counties. Urban and Type 4 rural counties had slightly higher AAIR for cancers associated with alcohol use (137.4 and 137.3) and low physical activity (97.4 and 97.0). Type 1 rural counties had higher AAIR for cancers associated with tobacco use (214.1) and HPV (13.2). For late-stage AAIR, Type 1 rural counties had significantly higher rates for all cancers combined (123.7) and for every type of behavior-related cancers. Type 1 rural counties also had a significantly higher AAMR (197.1) than all other types of counties (AAMR ranges between 168.5 and 177.6). Conclusions: Based on relevant population and health-resource characteristics, there appear to be four distinct types of rural places. Rural places that have lower economic resources and more racial/ethnic minority experience higher cancer health disparities reflected in higher incidence rates for certain behavior-related cancers, higher late-stage incidence rates, and higher mortality rate.
Citation Format: Xi Zhu, Amanda R Kahl, Mary E Charlton. Intersectionality in cancer health disparities: Rurality, socioeconomic factors, and health resources [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 A062.