Abstract B56: The impact of health care accessibility on cancer-related behaviors and outcomes in NA populations within the Northern High Plains.
Authors: Belasco Eric , Wilkes Ethan , Pence Barbara 
Published: August 2014

Abstract
Purpose: This research evaluates the impact from changes in preventative and behavioral factors on late stage cancer detection in areas of extremely low access to health care services. In focusing on the Northern High Plains (NHP) region, we are able to compare counties with extremely low access to health services to that of counties with relatively high levels of access. The findings from this research are critical in identifying health disparities in Native American (NA) populations as well as begin to determine the most effective means to deliver health services to areas where geography, economics, and culture might prevent traditional models of health delivery to operate effectively.
Empirical Methods: County-level cancer incidence data between 2005-2009 are collected from SEER databases for four states within the NHP (MT, WY, ND, and SD). Total cancer incidence data are split by stage at detection (localized, regional, metastatic). Economic data used in this study include data from the American Community Survey, 2010 Census, and BRFSS. Using this data the Health Care Accessibility index is computed through the use of principal component analysis and includes economic variables as well as variables concerning physical and geographic access to health care. The computed index provides a single metric that can be used to evaluate and rank access to health care for counties within our sample. The index is then regressed onto cancer outcomes (percentage of stage 3 cancers, relative to overall incidence), cancer prevention outcomes (percentage of population that receives appropriately recommended screenings), and cancer-related risk behaviors (percentage of population that smokes cigarettes and that is classified as obese). County-level regressions are used to identify correlations between outcome variables and the index, while controlling for other factors. Quantile regressions are also used to assess the impact of covariates on counties with extremely poor access to health services.
Results: Main findings from this analysis include: (1) Counties with relatively poor access to health care have lower rates of prevention activities, higher risk-related behaviors, and cancers are detected at later stages; (2) areas with the poorest access to health care services are found on or adjacent to NA reservation territories; (3) areas with high NA have high obesity rates, high smoking rates, and low access scores; (4) poor access to health services strongly correlates with low breast cancer screening rates; (5) counties with the poorest access may have large increases in screening rates for relatively mild gains in accessibility.
Conclusions: While both prevention and risk-related behaviors are known to impact the early detection of many cancers, this research identifies the rather complex web of economic issues that impacts adverse cancer outcomes. In order to more frequently detect cancer at early stages, it is crucial that (1) cancer-related prevention activities are expanded and (2) risk-related behaviors are mitigated. Counties in our sample that have poor access to health care are adversely impacted by both behaviors, which are shown to be directly influenced by a collection of economic indicators which are included in our index.
Citation Format: Eric Belasco, Ethan Wilkes, Barbara Pence. The impact of health care accessibility on cancer-related behaviors and outcomes in NA populations within the Northern High Plains. [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 B56.