Cancer outcomes, screening rates, and health behaviors by county-level poverty status.

Abstract

e23128 Background: Persistent poverty is associated with enduring structural barriers to cancer prevention and care, a challenge further magnified in predominantly rural states in which access constraints place communities at risk for lower screening uptake and more advanced cancer diagnosis. However, little is known about differences in cancer-related health behaviors, screening rates, and outcomes by county-level poverty status. Thus, we sought to compare health behaviors, screening rates, and cancer outcomes by county-level poverty status in a rural state (Oklahoma). Methods: We classified Oklahoma counties as persistent poverty counties (PPCs), defined as having ≥20% of residents living in poverty for ≥30 years, based on the U.S. Economic Development Administration criteria (2022; 18 counties). We categorized current poverty counties (CPCs) as those with ≥20% of residents living in poverty in 2022 but not meeting PPC criteria, based on the Small Area Income and Poverty Estimates (2022; 24 counties). We categorized remaining counties as non-poverty counties (NPCs), with <20% of residents living in poverty (35 counties). We obtained county-level sociodemographic characteristics and health behaviors from the University of Wisconsin Population Health Institute County Health Rankings (2022). We gathered breast and colorectal cancer screening rates (2022) from the Centers for Disease Control and Prevention PLACES data repository. We obtained age-adjusted incidence and mortality rates from OK2Share for lung, breast, and colorectal cancers (2018–2022). We evaluated group differences across PPCs, CPCs, and NPCs using one way analysis of variance. Results: Among Oklahoma counties, average county rurality (85.9% [PPCs] vs 76.0% [CPCs] vs 62.2% [NPCs]; p=.011) differed significantly by county poverty status. Health behaviors also differed across county groups, with higher rates of smoking in PPCs (22.6% vs 19.9% [CPCs] vs 18.0% [NPCs]; p<.001) and physical inactivity (35.1% vs 32.8% [CPCs] vs 30.4% [NPCs]; p<.001). Cancer screening rates were lower in PPCs for colorectal cancer (50.9% vs 52.8% [CPCs] vs 54.3% [NPCs]; p<.001) and breast cancer (64.5% vs 66.9% [CPCs] vs 68.1% [NPCs]; p<.001). Notably, lung cancer incidence and age-adjusted mortality rates were highest in PPCs (incidence: 77.5 vs 70.0 [CPCs] vs 60.9 [NPCs] per 100,000; p=.001; mortality: 54.6 vs 50.7 [CPCs] vs 44.5 [NPCs] per 100,000; p=.003), while breast and colorectal cancer incidence and mortality did not differ significantly across county groups. Conclusions: At the county level in a largely rural state, PPCs had higher rates of smoking and physical inactivity, lower rates of cancer screening, and higher lung cancer incidence and mortality than CPCs and NPCs. Findings highlight the need for targeted strategies to enhance cancer prevention and optimize oncologic care delivery for individuals living in areas with persistent poverty.