BACKGROUND AND PURPOSE:

• Social determinates of health (SDoH) influence the rate at which certain populations uptake recommended cancer screenings, but little is known about how this plays out at the county level
• The social vulnerability index (SVI) is one SDoH measure that can be used to identify populations with fewest resources and least access to health care
• Bauer et al. (JAMA Network Open, 2022) examined the geographic variation of USPSTF breast, cervical, and colorectal cancer screening rates and the association between county-level SVI and the 3 screening rates

METHODS:

• Population-based cross-sectional study
• Data
  • County-level information from the CDC PLACES and SVI data sets
  • From 2018 
• Exposures
  • SVI score categorized in quintiles
• Study design
  • Odds ratios were calculated for each cancer screening by SVI quintile as
    • Unadjusted odds ratio (OR): Only accounting for eligible population per county
    • Adjusted odds ratio (aOR): Urban-rural status | Percentage of uninsured adults | Primary care physician rate per 100,000 residents
• Primary outcome
  • County-level rates of USPSTF guideline concordant, up-to-date breast, cervical, and colorectal screenings

RESULTS:

• 3141 counties
• County-level cancer screening rates showed regional disparities that ranged from
  • Breast cancer screening: 54.0% to 81.8%
  • Cervical cancer screening: 69.9% to 89.7%
  • Colorectal cancer screening: 39.8% to 74.4%
• Higher SVI was significantly associated with lower odds of cancer screening
  • Lowest odds of screening occurred in the highest SVI quintile
• Comparing the highest quintile of SVI (SVI-Q5) with the lowest quintile of SVI (SVI-Q1), unadjusted and adjusted odds of cancer screenings were significantly lower
  • Breast cancer screening
    • OR 0.86 (95% Credible Interval [CrI], 0.84 to 0.87)
    • aOR 0.92 (95% CrI, 0.90 to 0.93)
  • Cervical cancer screening
    • OR 0.80 (95% CrI, 0.79 to 0.81)
    • aOR 0.87 (95% CrI, 0.86 to 0.88)
  • Colorectal cancer screening
    • OR 0.72 (95% CrI, 0.71 to 0.73)
    • aOR 0.86 (95% CrI, 0.85 to 0.88)

CONCLUSION:

• There were county-level disparities in recommended cancer screening
  • Counties with higher social vulnerability had lower rates of USPSTF recommended cancer screenings
• The authors state

Assessing area-level social vulnerability encompassing various SDoH allows us to capture conditions that affect all individuals living in the same area, either from compositional or contextual effects

Further research on assessing the optimal interventions to reduce disparities and improve uptake in cervical cancer screening is crucial to reverse this increasing incidence trend in less affluent areas and overall declining screening rates

Learn More – Primary Sources:

County-Level Social Vulnerability and Breast, Cervical, and Colorectal Cancer Screening Rates in the US, 2018