Rural–Urban Disparities in Health Access Factors Over Time: Implications for Cancer Prevention and Health Equity in the Midwest

Abstract

Purpose: Population-level environmental and socioeconomic factors may influence cancer burden within communities, particularly in rural and urban areas that may be differentially impacted by factors related to health care access. Methods: The University of Kansas (KU) Cancer Center serves a geographically large diverse region with 75% of its 123 counties classified as rural. Using County Health Rankings data and joinpoint regression, we examined trends in four factors related to the socioeconomic environment and health care access from 2009 to 2017 in rural and urban counties across the KU Cancer Center catchment area. Findings: The adult health uninsurance rate declined significantly in rural and urban counties across the catchment area (rural annual percent change [APC]=−5.96; 95% CI=[−7.71 to −4.17]; urban APC=−5.72; 95% CI=[−8.03 to −3.35]). Childhood poverty significantly decreased in rural counties over time (APC=−2.94; 95% CI=[−4.52 to −1.33]); in contrast, urban childhood poverty rates did not significantly change before 2012 (APC=3.68; 95% CI=[−15.12 to 26.65]), after which rates declined (APC=−5.89; 95% CI=[−10.01 to −1.58]). The number of primary care providers increased slightly but significantly in both rural and urban counties (APC=0.54; 95% CI=[0.28 to 0.80]), although urban counties had more primary care providers than rural areas (76.1 per 100K population vs. 57.1 per 100K population, respectively; p =0.009). Unemployment declined significantly faster in urban counties (APC=−10.33; 95% CI=[−12.16 to −8.47]) compared with rural counties (APC=−6.71; 95% CI=[−8.22 to −5.18]) ( p =0.02). Conclusion: Our findings reveal potential disparities in systemic factors that may contribute to differences in cancer prevention, care, and survivorship in rural and urban regions.