Understanding the Influence of Community-level Deprivation and Rural Residence in Cancer Care

Dartmouth-Hitchcock Clinic, Lebanon NH

Investigators

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Abstract

PROJECT SUMMARY/ABSTRACT Project 3 (Loehrer): Understanding the Influence of Community-Level Deprivation and Rural Residence in Cancer Care Delivery Lack of insurance coverage and individual income have been associated with considerable disparities in cancer care for patients with solid organ malignancies, including later-stage disease at time of presentation, decreased probability of undergoing cancer-directed surgery, and decreased survival. However, much less is understood about upstream geospatial determinants of health that influence access to, and receipt of, cancer care for the 20% of Americans that live in rural communities. The manner in which patient-level characteristics, such as insurance coverage, interact with these geospatial factors across diverse rural communities remains unclear. Finally, significant gaps persist in understanding how these data can be used to best meet the challenges of local and state policy aimed at improving equity of cancer care across diverse populations. To address these gaps, Dr. Loehrer plans to conduct a population-based observational cohort study to evaluate the influence of rural residence, community-level socioeconomic deprivation, and their interaction with insurance coverage on presentation with, and management of, solid organ malignancies. Additionally, mixed- methods approaches will engage community members, as well as local and state policymakers, to understand how these data can be applied, presented, and disseminated to improve equity of cancer care delivery. The study capitalizes on the novel use of select state cancer registries with geographically-linked measures of community-level socioeconomic deprivation. Multilevel quantitative methods, geovisualization, geocomputational approaches, spatiotemporal analyses, and mixed methods will all be used to describe and visualize complex relationships between insurance coverage, rural residence, and local community-level socioeconomic factors. The study will provide important information on upstream geospatial drivers of cancer care disparities while also evaluating the best way to combine quantitative and geospatial data, community experience and priorities, and realities of policy development and implementation to best address equity of cancer care delivery for rural populations.