Rural areas show higher skin cancer rates, especially in skin of color

Key takeaways:

• Individuals living in rural areas, especially those with skin of color, were more likely to have positive skin cancer history.
• This did not include those with a household income higher than $100,000.

Rural populations, especially those with skin of color, experience higher prevalence and an increased risk for skin cancer, according to a study.

“Previous studies have shown that there is a higher risk for skin cancer disease burden in rural populations,” Rachel R. Lin, BS, a student at University of Miami Miller School of Medicine, told Healio.

However, few studies have evaluated the role of social determinants of health on urban-rural health disparities including, sex, age, race, insurance status, number of personal health care providers and household income.

“Since skin cancer has a great prognosis when identified early,” Lin said. “Connecting rural patients to dermatological care is crucial.”

Lin and colleagues conducted a cross-sectional study to explore social determinants roles in skin cancer. Data were collected from the 2018 to 2021 Behavior Risk Factor Surveillance Survey, an annual telephone-based survey in which adult participants are randomly selected. The researchers analyzed data from 170,871 participants residing in California, Florida, Georgia, Michigan and Tennessee, which are states with a fair distribution of both rural and urban centers.

Results showed that rural populations had a higher prevalence of skin cancer history across races (P < .01). However, while rural non-Hispanic white patients had greater odds of contracting skin cancer than their urban counterparts (OR = 1.4; 95% CI, 1.34-1.46), the odds were twice as high for rural patients that identified as Black (OR = 1.74; 95% CI, 1.14-2.65), Hispanic (OR = 2.31; 95% CI, 1.56-3.41) and a non-Hispanic other race (OR = 1.99; 95% CI, 1.51-2.61). No significant difference was detected among American Indian or Alaskan Native individuals.

On the other hand, individuals the most at risk for developing skin cancer in rural areas were Asians with an over 20-times increased risk (OR = 20.46; 95% CI, 8.63-48.54).

“I did not expect to see the largest discrepancy in urban/rural skin cancer rates in Asian populations,” Lin said. “Since the Asian community encompasses many different ethnicities, further research into this association is needed.”

Among all social determinants of health, rural counterparts were significantly more likely to have positive skin cancer history, except when earning a household income greater than $100,000. In fact, there was no difference observed between urban and rural settings in prevalence or odds of skin cancer when households earned more than $100,000.

“Whether this is due to increased access to preventative care, sun-protection/skin cancer education, or decreased environmental exposure is unclear,” Lin told Healio. “However, it is a testament to the role social determinants of health have on health outcomes.

“While no direct clinical implications can be drawn from these associations, this study highlights the need for increased specialty care in rural areas,” Lin said.