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Decreased Cancer Mortality-to-Incidence Ratios with Increased Accessibility of Federally Qualified Health Centers

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Abstract

Federally qualified health centers (FQHCs) offer primary and preventive healthcare, including cancer screening, for the nation’s most vulnerable population. The purpose of this study was to explore the relationship between access to FQHCs and cancer mortality-to-incidence ratios (MIRs). One-way analysis of variance was conducted to compare the mean MIRs for breast, cervical, prostate, and colorectal cancers for each U.S. county for 2006–2010 by access to FQHCs (direct access, in-county FQHC; indirect access, adjacent-county FQHC; no access, no FQHC either in the county or in adjacent counties). ArcMap 10.1 software was used to map cancer MIRs and FQHC access levels. The mean MIRs for breast, cervical, and prostate cancer differed significantly across FQHC access levels (p < 0.05). In urban and healthcare professional shortage areas, mean MIRs decreased as FQHC access increased. A trend of lower breast and prostate cancer MIRs in direct access to FQHCs was found for all racial groups, but this trend was significant for whites only. States with a large proportion of rural and medically underserved areas had high mean MIRs, with correspondingly more direct FQHC access. Expanding FQHCs to more underserved areas and concentrations of disparity populations may have an important role in reducing cancer morbidity and mortality, as well as racial-ethnic disparities, in the United States.

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Acknowledgments

This publication was supported by Cooperative Agreement Number U48/DP001936 from the Centers for Disease Control and Prevention (Prevention Research Centers) and the National Cancer Institute (PIs: Dr. Hébert, Dr. Friedman). This work also was partially supported by: an Established Investigator Award in Cancer Prevention and Control from the Cancer Training Branch of the NCI to Dr. Hébert (K05 CA136975), U54 CA153461-01 from the National Cancer Institute, Center to Reduce Cancer Health Disparities (Community Networks Program) to the South Carolina Cancer Disparities Community Network-II (SCCDCN-II), and an NCI K01 Career Development Grant to Dr. Tucker-Seeley (K01 CA169041). Dr. Yip was partially supported by the National Cancer Institute (R01 CA 124397; PI: S-P Tu).

Conflict of interest

No financial disclosures were reported by the authors of this paper.

Author information

Authors and Affiliations

  1. Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA

    Swann Arp Adams, Seul Ki Choi, Daniela B. Friedman, Jan M. Eberth, Sudha Xirasagar & James R. Hébert

  2. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA

    Swann Arp Adams, Jan M. Eberth & James R. Hébert

  3. College of Nursing, University of South Carolina, 1601 Greene street, Columbia, SC, 29208, USA

    Swann Arp Adams

  4. Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene street, Columbia, SC, 29208, USA

    Seul Ki Choi & Daniela B. Friedman

  5. Department of Public Health, California State University, Fresno, 2345 E. San Ramona Avenue M/S MH30, Fresno, CA, 93740, USA

    Leepao Khang

  6. South Carolina Primary Health Care Association, 3 Technology Circle, Columbia, SC, 29203, USA

    Dayna A. Campbell & Vicki M. Young

  7. School of Medicine and Colorado Health Outcomes Research Program, University of Colorado at Denver, 13199 E Montview Blvd, Suite 300, Aurora, CO, 80045, USA

    Russell E. Glasgow

  8. Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA

    Reginald Tucker-Seeley

  9. Center for Community Based Research, Dana-Farber Cancer Institute, 450 Brookline Avenue, LW703, Boston, MA, 02215, USA

    Reginald Tucker-Seeley

  10. Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA

    Sudha Xirasagar

  11. Division of General Internal Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA, 98104, USA

    Mei Po Yip

Authors
  1. Swann Arp Adams
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  2. Seul Ki Choi
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  3. Leepao Khang
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  4. Dayna A. Campbell
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  5. Daniela B. Friedman
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  6. Jan M. Eberth
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  7. Russell E. Glasgow
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  8. Reginald Tucker-Seeley
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  9. Sudha Xirasagar
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  10. Mei Po Yip
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  11. Vicki M. Young
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  12. James R. Hébert
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Corresponding author

Correspondence to Swann Arp Adams.

Electronic supplementary material

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10900_2014_9978_MOESM1_ESM.eps

Figure S1. Access to FQHCs and colorectal cancer MIRs by region. (a) West, (b) Midwest, (c) Northeast, (d) Southwest, (e) Southeast. Supplementary material 1 (EPS 4107 kb)

10900_2014_9978_MOESM2_ESM.eps

Figure S2. Access to FQHCs and prostate cancer MIRs by region. (a) West, (b) Midwest, (c) Northeast, (d) Southwest, (e) Southeast. Supplementary material 2 (EPS 4107 kb)

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Adams, S.A., Choi, S.K., Khang, L. et al. Decreased Cancer Mortality-to-Incidence Ratios with Increased Accessibility of Federally Qualified Health Centers. J Community Health 40, 633–641 (2015). https://doi.org/10.1007/s10900-014-9978-8

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  • DOI: https://doi.org/10.1007/s10900-014-9978-8

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