‘Socially vulnerable’ locations have lower cancer screening rates
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U.S. counties considered more socioeconomically vulnerable had cancer screening rates below federally recommended guidelines, according to study results published in JAMA Network Open.
The analysis — which used CDC’s social vulnerability index (SVI) — showed residents of these counties had significantly lower odds of receiving the recommended cancer screening for breast, cervical and colorectal cancer, the investigators noted.
Background
CDC developed the SVI score to identify communities that are most vulnerable to the effects of extreme events and may have fewer public health care resources for response, according to Ryan Suk, PhD, MS, assistant professor at UTHealth School of Public Health in Houston.
The validated matrix has previously demonstrated associations with utilization of health care resources and health-related outcomes, she added.
“We also noticed that [SVI] is still very underutilized in other health-related outcomes despite its strength of being a scalable composite score that reflects the multidimensional area-level social determinants of health,” Suk told Healio. “Because our research interests are cancer prevention, we thought it would be a great tool to assess the association between geographic disparities in cancer screening and area-level social determinants of health.”
Methodology
Suk and colleagues conducted a population-based cross sectional analysis using data from the CDC’s PLACES and SVI databases. The analysis — performed from October 2012 through February 2022 — includes data from 2018 for 3,141 counties in the United States.
Investigators ranked SVI scores on a scale of 0 to 1 and divided the scores into quintiles (0 to < 0.2, 0.2 to < 0.4, 0.4 to < 0.6, 0.6 to < 0.8 and 0.8 to 1), with the first quintile, representing the least socially vulnerable locations, serving as the reference group.
County-level concordance with cancer screening based on U.S. Preventive Services Task Force (USPSTF) guidelines for breast, cervical and colorectal cancer served as the study’s primary outcome.
Key findings
Results showed a mean county-level screening rate of 70.8 ± 4% (range, 54-81.8) for breast cancer, 83.9% ± 1.9% (range, 69.9-89.7) for cervical cancer and 61.9 ± 4.8% (range, 39.8-74.4) for colorectal cancer.
“Cancer screening rates presented substantial geographic variations, with all three screening rates being higher among the counties on the east and west coasts and lower in the South and Midwest,” Suk and colleagues wrote. “Maps of the screening rates and SVI categories presented clear geographic patterns, as counties with a higher SVI score also tended to have lower screening rates.”
A multivariate analysis showed a significant association between higher SVI score and lower cancer screening rates, with the lowest odds of screening occurring in the highest SVI quintile.
Investigators found the following unadjusted ORs and 95% posterior credible intervals (Crl) when comparing the highest vs. lowest SVI quintile:
- 0.86 (95% CrI, 0.84-0.87) for breast cancer screening;
- 0.8 (95% CrI, 0.79-0.81) for cervical cancer screening; and
- 0.72 (95% CrI, 0.71-0.73) for colorectal cancer screening.
Fully adjusted ORs when comparing highest vs. lowest SVI quintile included:
- 0.92 (95% CrI, 0.9-0.93) for breast cancer screening;
- 0.87 (95% CrI, 0.86-0.88) for cervical cancer screening; and
- 0.86 (95% CrI, 0.85-0.88) for colorectal cancer screening.
Clinical implications
“Our analysis once again emphasizes that improving overall average screening rates should not be the only main goal of public health initiatives,” Suk told Healio.
Results such as those seen for cervical cancer are particularly noteworthy, she said.
“Some populations have very low cervical cancer screening uptake, while in other areas, the screening rate is higher than the national target rate,” Suk said. “Average rate can mask these various geographic disparities associated with social vulnerability, and we need to pay more effort to reducing these disparities and developing more effective targeted interventions based on these real-world data.”
Additionally, Suk said colorectal cancer had a noticeably lower overall screening rate than other cancer types evaluated in their study and suggested that health care providers reinforce the importance of these screenings with their patients.
“We are hoping that our data-driven evidence can better inform community-based practitioners in understanding the association between patients’ social needs and screening uptake to incorporate into their cancer screening promotion programs,” she said. “Evidence shows that screening patients’ social needs with navigation programs helps identify patients with certain basic needs and connects them with adequate services.”
For more information :
Ryan Suk, PhD, MS, can be reached at Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler St., RAS-E915, Houston, TX 77030; email: ryan.suk@uth.tmc.edu.
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