A groundbreaking study published in JAMA Network Open by the Harvey L. Neiman Health Policy Institute reveals poverty, environmental risks, housing issues and physical inactivity are top-ranked community level predictors of disparities in cancer screening, prevalence and deaths broken down by counties across the U.S. Fueled by data, interactive Neiman Cancer Disparity Maps on the Institute’s website illustrate where poor outcomes and high-risk conditions overlap, offering actionable insights for researchers, policymakers, government agencies and health systems.
“For the four most prevalent cancers in the U.S. – breast, colorectal, lung and prostate cancers – we now know that community conditions like tobacco use, air pollution, insurance coverage, housing and environmental mitigation are critical for understanding the cancer screening gaps, excess prevalence and preventable deaths that afflict many communities,” said Elizabeth Y. Rula, Ph.D., executive director of the Neiman Institute. “These maps bring this information together in an easy-to-use tool that can help leaders target interventions and resources where they can save the most lives.”
The researchers developed a machine-learning model that ranked 24 county-level factors by their relative importance for explaining differences in cancer screening, prevalence and mortality rates.
“Poverty rate was the most consistently important predictor of community cancer outcomes across cancer types,” explained Alexandra Drake, MPH, senior analyst at the Neiman Institute and the study’s lead author. “Environmental risks, including air toxics, were also high ranking, as were housing issues and physical inactivity, revealing critical focus areas to maximize public health impact.”
Air toxics were, by far, the most important factor for prostate cancer screening. Air pollution and air toxics were both strong predictors of lung cancer screening – outranking the county smoking rate, which predictably topped the list of important factors for lung cancer mortality. Among counties ranking the worst for smoking and lung cancer mortality, seven out of 10 were in Kentucky.
These results highlight the importance of prevention via tobacco control and environmental mitigation, and the need to expand lung cancer screening to save lives. Only 16% of eligible Americans are screened.1 The second most important factor for lung cancer screening was access to primary care physicians, which reflects our recent study finding that smokers were nearly a third more likely to keep up with screening if they talked about lung cancer screening with their doctor, called shared decision making. Primary care providers are key for increasing screening rates.
Certain parts of the country were hotbeds for breast cancer risk factors and worse outcomes. Texas had the worst breast cancer screening rates and high uninsured rates. Even counties near Dallas, such as Johnson, were among the worst in the country for both measures.
Community conditions and socioeconomics were among top factors for every type of cancer and outcome. In particular, the rate of severe housing problems, including overcrowding and high housing costs, were of high importance for three types of cancer prevalence. The maps showed regional patterns with worse housing problems along the East and West coasts along with higher cancer prevalence.
“This research reveals opportunities for action for health systems. For example, Loyola Medicine’s patients in the Chicago Metro area have high breast cancer prevalence combined with high air pollution compared to other parts of the U.S.,” said William Small Jr., MD, director of the Loyola Cardinal Bernadin Cancer Center, coauthor and advisor to the Neiman maps project. “At our cancer center, we are using these data to better understand challenges for the populations we serve to plan targeted community outreach efforts to decrease the burden of cancer in specific areas.”
The project was supported by partners and advisors – a group of seven nationally recognized experts in cancer prevention and health equity. The project received support from the Amazon Web Services (AWS) Health Equity Initiative and the Radiology Health Equity Coalition.
“The Neiman Cancer Disparity Maps are a key resource to help prioritize and unify efforts to reduce the greater burden of cancer carried by some communities and groups,” said Carla Braithwaite, executive director of the Radiology Health Equity Coalition. “This powerful data can help align funding with local needs to maximize public-health impact and rectify inequities.”
1 https://www.lung.org/research/state-of-lung-cancer/key-findings
