The Impact of Rural Health Care Accessibility on Cancer-Related Behaviors and Outcomes

By Belasco, Eric J.; Gong, Gordon et al. | Applied Health Economics and Health Policy, August 2014 | Go to article overview

The Impact of Rural Health Care Accessibility on Cancer-Related Behaviors and Outcomes


Belasco, Eric J., Gong, Gordon, Pence, Barbara, Wilkes, Ethan, Applied Health Economics and Health Policy


Published online: 3 June 2014

© Springer International Publishing Switzerland 2014

Abstract

Background This research seeks to identify the relationship between economic factors related to the ability to receive and pay for health services and adverse cancer outcomes, as well as preventative screening and behavioral factors that influence the risk of cancer. We focus on the Northern High Plains region, where we are able to compare regions with extremely low access to health services with those with relatively high levels of access.

Objective This study aims to identify health disparities in rural communities, particularly among Native American populations, and, thereby, begin to determine the most effective means by which to deliver health services to areas where geography, economics, and culture might prevent traditional models of health delivery from providing sufficient incentives for the prevention of adverse cancer-related outcomes.

Methods The Health Care Accessibility Index (HCAI) is computed through the use of principal component analysis and includes economic variables as well as variables concerning institutional and geographic access to health care. Index values are then regressed onto cancer outcomes, cancer-prevention outcomes, and cancer-related risk, using weighted least squares and quantile regressions.

Results Counties with relatively poor access to health care (low HCAI) also have statistically (1) lower breast cancer screening rates, (2) higher smoking prevalence, (3) higher obesity prevalence, and (4) higher cancer-related mortality rates. Breast cancer screening is found to be especially sensitive to areas of low health accessibility.

Conclusions Empirical results provide support for policy efforts to increase the accessibility of health care services that are targeted to areas with low mammography screening rates, high obesity rates, high smoking prevalence, as well as areas near Native American reservation territories.

1 Introduction

Lifestyle and socioeconomic factors, as well as cancer screening behaviors, are important determinants of late-stage cancer incidence rates [1]. The relationship between these determinants and incidence rates is important, in part, because they are the main policy tools in combating cancer. As described by Cutler [2], the four main cancer sites (lung, colorectal, female breast, and prostate) have had decreased US age-adjusted mortality rates since the early 1990s. Cutler attributes these reductions to three main factors: (1) behavioral changes (e.g., reduced smoking); (2) more effective and prevalent screening of breast, colon, and prostate cancers; and (3) more effective chemotherapy and surgery. Of the three factors listed, nearly 60 % of the observed decrease can be attributed to behavioral changes and improved/more prevalent screening.

However, these gains have not been experienced across all demographics. One notable subpopulation that has not experienced the substantial gains in early cancer detection is that of Native Americans [3]. For example, Native American women were the only demographic group that did not experience reductions in cancer mortality rates from 1997 to 2007 [4]. Holm et al. [5] performed a study that focused on North Dakota and found that Native Americans were less likely to meet age-appropriate screening recommendations than samples taken from the USA and North Dakota. A lack of preventative screening for cancer is associated with demographic factors, such as age, education level, and marital status, and is also importantly related to economic variables, such as whether someone is unemployed, has a regular health care provider, has health insurance, and is a non-smoker [6]. Native Americans were also more likely to smoke cigarettes, not engage in leisure time physical activity, and be unemployed. The result of this combination of cancer-related risk factors is that Native American Indians and Alaska Natives are also more likely to have late-stage disease diagnosis than non-Hispanic whites [7]. …

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