Abstract A05: Does community-level access to healthcare moderate the adverse effect of community socioeconomic deprivation on prostate and colorectal cancer mortality rates?
Authors: Freeman Vincent L. , Barrett Richard E. , Booth Benjamin J. , McLafferty Sara L. , Shockley Alisa , Simanis Joseph M. , Pauls Heather , Campbell Richard T. 
Published: August 2014

Abstract
Introduction and Objective: Some socioeconomically disadvantaged urban communities experience significantly higher mortality rates from cancer than more affluent areas, whereas others do not. This study explored whether community-level healthcare access-related factors in an urban setting modified the association of community socioeconomic disadvantage with increased cancer-related mortality.
Methods: We used linear regression models to analyze the association of concentrated disadvantage (CD), a multidimensional area-based measure of SES, with age-adjusted prostate and colorectal cancer mortality rates in the 77 community areas of Chicago, Illinois before and after stratification by measures of community access to healthcare. For each community, we calculated a CD score using data from the 2000 U.S. census and the subsequent 5-year age-adjusted cumulative mortality rates from prostate and colorectal cancer using data from the Chicago Department of Public Health. We also characterized each community area with respect to the density of prostate and colorectal cancer-related physicians and medically underserved area/population (MUA/MUP) designation status as of 2000 using data from the American Medical Association and the U.S. Department of Health and Human Services-Health Resources and Services Administration (DHHS-HRSA), respectively.
Results: Community area CD score was strongly associated with 5-year cumulative mortality rates from prostate and colorectal cancers (p &lt; 0.0001, R2 = 0.440 and 0.223, respectively). Physician density did not modify the association. However, CD was not associated with increased prostate and colorectal cancer mortality rates in community areas with an MUA/MUP designation of 7 years or more (p = 0.31 and 0.87 for prostate and colorectal cancer, respectively). Moreover, the cancer mortality rates in communities with a long-standing MUA/MUP designation were not significantly higher than those of more affluent communities (p = 0.36 and 0.99 for prostate and colorectal cancer, respectively).
Conclusion: Over time, an MUA/MUP designation may moderate the association between community-level socioeconomic disadvantage and increased mortality from prostate and colorectal cancers in socioeconomically deprived urban communities. A sustained increase in access to health care infrastructure, providers and services that usually follows a MUA/MUP designation through DHHS-HRSA could help explain this moderating effect.
Citation Format: Vincent L. Freeman, Richard E. Barrett, Benjamin J. Booth, Sara L. McLafferty, Alisa Shockley, Joseph M. Simanis, Heather Pauls, Richard T. Campbell. Does community-level access to healthcare moderate the adverse effect of community socioeconomic deprivation on prostate and colorectal cancer mortality rates? [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A05.