Exploring Rural Disparities in Breast Cancer Mortality
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Introduction Women in Humboldt County (HC) are dying from breast cancer (BC) at an excessive rate, which concerns many community members. While women who live in HC appear to get BC at a similar rate as women in the rest of California (CA), HC women with BC are more likely to die from it. Women diagnosed with BC at a late stage are more likely to die from it; however, research has shown that women in HC are not necessarily diagnosed any later than women living in other CA counties. This research project will explore possible reasons for the high BC death rate in HC. The medically underserved county has some unique characteristics: low population density (rural and frontier areas), high poverty, high death rates due to all causes and all cancers, and a high percent of American Indians. Moreover, low-income individuals often lack health insurance, transportation, Internet access, or a phone. We will explore geographic and demographic factors that may be associated with the high breast cancer death rate (mortality) in HC.
 
 
 
 
 
 
 
 Questions: In Humboldt County, what factors are associated with higher BC mortality? Do women living in frontier or rural areas of California have higher BC mortality rates compared to urban areas of CA?
 
 
 
 
 
 
 
 
 
 General methodology: We will analyze existing data about BC deaths. Specifically, we will: 
 
 
 
 1. Analyze data from a state registry with information about people diagnosed with cancer to determine what types of women in HC are dying from BC, specifically looking at race/ethnicity, age at diagnosis, stage and type of cancer, type of neighborhood a woman lives in (neighborhood poverty and education level, and rural vs. frontier), and determine travel distance from residence to treatment facilities using residence information.
 
 
 
 2. Determine if the BC death rate in CA is different in low-population areas (frontier and rural) versus high-population areas (urban).
 
 
 
 
 
 
 
 
 
 Innovative elements: Unique to this project will be the first-time analysis of BC related deaths in CA based on population density. There have been few research studies that have examined how population density affects BC death rates. Research has shown that rural populations tend to have more health problems compared to urban populations, and this study will help understand what may be contributing to this.
 
 
 
 
 
 
 
 
 
 Community involvement: The high death rate from BC has long concerned both county health officials and community health advocates alike, but until now, there has not been the opportunity to adequately investigate factors that may contribute to this. The Humboldt Community Breast Health Project, a direct services breast health advocacy organization, is partnering with the California Center for Rural Policy to address community concerns about the high BC death rates in HC. The partners have co-developed the long term goals, research proposal and collaborative agreement. The community will be engaged through a Community Advisory Council who will advise on all phases of the research: refining research questions, methods for data collection, analysis, and interpretation, and how results are shared with the community. Members range from BC specialists, primary care providers, and health advocates, to BC survivors. Once the data analysis is completed, community liaisons will be consulted with about the best ways to communicate study findings with their community. They will also be trained as local resource experts on how to interpret the results of the study. Community forums will be held to disseminate and discuss the findings with community members, as well as discuss potential next steps to solving this paradox. We aim to actively engage any community member who seeks to be involved in the research. 
 
 
 
 
 
 
 
 
 
 Future Plans: As relationships between the community and researchers develop during the pilot study, the research-community partnership will have the skills and structure to pursue future research to address disparities in rural BC survivorship. Pilot study findings will have described the population of women who are dying at higher rates from breast cancer and identified the main factors associated with higher BC mortality in HC, and will have compared BC mortality rates between women living in rural and frontier areas versus urban areas in HC and throughout the state of California. This will prepare us to further investigate these factors in a full study, to better understand how to increase BC survivorship in rural communities or studies focused on developing and testing programs to decrease the high BC death rate in HC.