The fact sheet summarizes cancer facts related to the Rural Poor population. The document is organized into seven sections: Who We Are, Causes/Etiology, Patient/Provider Communication, Screening, Disparities, Outcomes, and References.  See more at Intercultural Cancer Council Records

Intercultural Cancer Council

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The Texas Medical Center Library DigitalCommons@TMC Informational and Promotional Materials Intercultural Cancer Council Records 2011 Cancer Facts: Rural Poor Intercultural Cancer Council Follow this and additional works at: https://digitalcommons.library.tmc.edu/info_promo  Part of the Public Health Commons, and the Social Justice Commons Recommended Citation Intercultural Cancer Council, "Cancer Facts: Rural Poor" (2011). Informational and Promotional Materials. 12. https://digitalcommons.library.tmc.edu/info_promo/12 This Article is brought to you for free and open access by the Intercultural Cancer Council Records at DigitalCommons@TMC. It has been accepted for inclusion in Informational and Promotional Materials by an authorized administrator of DigitalCommons@TMC. For more information, please contact digcommons@library.tmc.edu. Rural PoorWe are the rural poor andmedically underserved living allacross the U.S. We representapproximately 7.3 million individuals(or 15.1%) of the rural population inAmerica compared to our 12.5%urban poor counterparts. In fact, ourrural poverty rates have always beenhigher than those living in urban areasand are also considered “persistent”,meaning a consistently high povertyrate for more than 40 years.(1) This isdue to many factors such as ourisolation and sparse population, ourlimited economic opportunities, andour lower educational levels amongour working adult population.The majority of us are non-Hispanic/Latino white (66.3%)compared to those living in urbanareas (40.4%).(1) We tend to live in theSouth which has the highest povertyrate at 13.8 percent.(2) In theAppalachia region alone, we numbermore than 22 million people in 404counties in 13 states betweenSouthwestern New York andMississippi. Central Appalachiaincludes the defined geographic areaof West Virginia, and parts ofKentucky, Tennessee, Virginia, andOhio where a higher proportion of thealmost entirely non-Hispanic/Latinowhite, largely rural population is poor.The Appalachian region hastraditionally experienced higherpoverty rates, lower education levels,and limited access to health carecompared to the nation as a whole.Approximately 65% of Appalachiancounties are rural: 42% of the region’sresidents live in these rural counties.Furthermore, 108 of the 404 countiesare categorized as distressed orseverely distressed.As rural individuals, we tend to beolder, poorer, less educated, and morelikely to be uninsured than our urbancounterparts. As such, we have higherrates of chronic illness and disabilitiesand are overall in poorer health thanour urban neighbors. Generally, wehave less contact and fewer visits withphysicians and, lower levels ofpreventive care. While poverty or lowsocioeconomic status has not beendirectly related to a higher incidenceof cancer, research has shown thatpoverty has an adverse effect oncancer survival rates.(3)WHOWEARECancer FactsProject DirectorNicholas K. Iammarino, PhD, CHESResearch AssistantsMohammed Ansar AhmedPrem RamkumarThese ICC Cancer Fact Sheets wereupdated through an educational grantfrom Ortho Biotech.Causes/Etiology Women who live in Appalachia are at higher risk for cervicalcancer than other U.S. women and, in particular, the rate ofcervical cancer mortality in Appalachian Kentucky is thehighest of the 13 Appalachian states, and about 50% higherthan nationwide rates.(4,5) Research suggests that lung cancer mortality rate is higher inthe coal-mining region of Appalachia. Risk factors such assmoking, mining, and also the correlation of poverty and loweducation all contribute to this data.(6) Major sources of employment in rural areas generally includeagriculture, mining, and forestry, with a high potential forwork-related injuries which raise the risk for cancerdevelopment.(7) Appalachians share similar values in terms of importance offamily, religion, and home as do American Indian andHispanic populations. Further, they also share problems suchas low socioeconomic status, lack of access to health care,and low educational attainment.(8) Access issues for Appalachians include physicians who tendto leave for urban settings after short periods and who are notnative to the area. This is further exacerbated with difficultyin understanding them and the likelihood of culturalmiscommunication.(9) Appalachian geography isolates many smaller communitiesfrom cities and healthcare resources. Mountain chains,valleys and rivers often separate small communities andinhibit transportation to health facilities.(10)Screening Conflicting guidelines, time constraints, and perceptions thatpatients do not value prevention were reported as barriersto cancer screening by rural Appalachian patient careproviders.(11) Hall et al. reported that the prevalence of recentmammography among women in Appalachia, which islargely rural, is lower than among other women in the UnitedStates.(12) Rural residence, geographic isolation, poverty,unemployment, lack of education, lack of child care services,and attitudinal and cultural factors may pose barriers tocancer screening among Appalachian women.(13) Breast cancer has more often been diagnosed at a late stagein rural Appalachia than elsewhere in the United States; thisis mainly associated with an absence of screening.(14, 15) A study conducted of Appalachian women inWest Virginia,reported that cost, fear, and embarrassment were identifiedas the top barriers to breast and cervical cancer screening.(16) Among Central Appalachian women, barriers to cervicalcancer screening include fear of being subjected to medicalscrutiny because of obesity or being a smoker, inadequatehealth care access, long travel time to medical servicesand clinic schedules that do not accommodate workingwomen.(17)Patient/Provider Communication Stitzenberg et al. reported the distance a patient has to travelto see the doctor who diagnoses their melanoma, the morelikely they are to have thicker and more lethal skin cancer atthe time of diagnoses.(18) Rural surgeons are often uneasy when their outcomes arecompared with those of urban surgeons, largely because theyperceive that rural patients typically present with worsedisease.(19, 20)Disparities Rural residents who are older, represent minorities, and are oflow-income status use fewer medical screenings and earlydetection options available, leading to late diagnosis andincreasing the mortality rate.(21)Rural Poor and Cancer2 The disproportionately high cancer-related mortality ratesstill persist even though the economic state of manyAppalachian counties have improved, recent findingsdemonstrate higher rates for selected types of cancers such ascervical, colorectal and lung.(22-24) Recent studies have identified higher rates of cancer and, inparticular, cervical cancer; heart disease; and prematuremortality in the Appalachian regional population.(25) Rural areas have the highest death rates for children andyoung adults with a 20% higher increase in lung and livercancer compared to metropolitan areas.(26) Elderly Americans who live in low income, rural area have a17%-39% higher chance of death after surgeries mainly due tothe quality of care at lower end rural hospitals.(27) Geographical differences are seen in a pattern of excessiveprostate cancer among African American/black males livingin rural Southeastern United States, with a much greaterprevalence among low socio-economic AfricanAmerican/blacks in that area.(28) Halverson’s analysis reported that besides poor nonHispanic/White Appalachians, mortality rates for AfricanAmerican/blacks who also live in Appalachia exceedednational African American/black mortality rates.(29)Outcomes The lung cancer rate for Appalachian men was nearly 25%higher than the rate for men living in the rest of the US. Thelung cancer rate for Appalachian women was 8% higher thanthe rate for women in the rest of the U.S.(30) From 2001-2003, Appalachian men and women had thehighest incidence rates in all sites combined (415 per100,000) when compared to the U.S. general population(398 per 100,000).(30)Rural Poor and Cancer 3 Couto et al. reported approximately 13% of Appalachians areconsidered to be medically indigent. The rate ofmammography among Appalachian women was 3.2% lowerthan the national rate, and the Papanicolaou (Pap) test ratewas 2.5% lower.(12, 31) Rural women in the United States have higher cervical cancerincidence rates. Among older women (aged 45–80 years) inwhom half of cervical cancers occur, geographic differenceslargely disappear after controlling for poverty and race.(32) The cancer prevalence and mortality rates for theAppalachian region is much higher in rural Appalachia thanall of Appalachia itself, with 176.3 per 100,000 compared to173.1 to 100,000 of total Appalachia. It is also significantlyhigher than the national cancer death rate of 166.7per100,000.(33)References1. Rural Realities. At the Razor’s Edge: Building Hope forAmerica’s Rural Poor. Updated 2006. Available at:http://ruralsociology.org/StaticContent/Publications/Ruralrealities/pubs/RuralRealities1-1.pdf. Accessed February2011.2. DeNavas-Walt C, Proctor BD. Income, Poverty, and HealthInsurance Coverage in the United States: 2006 U.S.Department of Commerce Economics and StatisticsAdministration US Census Bureau. Updated August 2007.Available at: http://www.census.gov/prod/2007pubs/p60-233.pdf. Accessed February 2011.3. Underlying Socioeconomic Factors Influencing HealthDisparities in the Appalachian Region Appalachia RegionalCommission. Available at: http://www.arc.gov/assets/research_reports/SocioeconomicFactorsInfluencingHealthDisparitiesinAppalachianRegion5.pdf. Accessed February2011.4. Huang B,Wyatt SW, Tucker TC, Bottorff D, Lengerich E, HallHI. Cancer Death Rates – Appalachia 1994–1998.MMWR.2002;51:527–29.5. Hall HI, Rogers JD,Weir HK, Miller DS, Uhler RJ. Breast andCervical Carcinoma Mortality amongWomen in theAppalachian Region of the US 1976–1996. Cancer. 2000;89:1593–1602.6. Hendryx M,O’Donnell K,Horn K. Lung Cancer Mortality isElevated in Coal-Mining Areas of Appalachia. Lung Cancer.2008. doi:10.1016/j.lungcan.2008.02.004.7. University of Pittsburgh Center for Rural Health Practice.Bridging the Health Divide: The Rural Public HealthResearch Agenda. 2004:16-20.8. Marshal CA. American Indian and Hispanic PopulationsHave Cultural Values and Issues Similar to Those ofAppalachian Populations. Prev Chron Dis. 2007;4(3):1-2.9. Documet PI, Green HH, Adams J, et al. Perspectives ofAfrican American, Amish, Appalachian and LatinaWomenon Breast and Cervical Cancer Screening: Implications forCultural Competence. J Health Care Poor Underserved.2008;19:56-74.10. Behringer G, Friedel GH, Dorgan KA, et al. Understandingthe Challenges of Reducing Cancer in Appalachia:Addressing a Place-Based health Disparity Population.California J Health Promot. 2007;5;40-49.11. Shell R, Tudiver R. Barriers to Cancer Screening by RuralAppalachian Primary Care Providers. J Rural Health.2006;20(4):268-73.12. Hall HI, Uhler RJ, Coughlin SS, Miller DS. Breast andCervical Cancer Screening among AppalachianWomen.Cancer Epidemiol Biomark Prev. 2002;11(1):137-42.13. U.S. Department of Health and Human Services. HealthyPeople 2010 (Conference Edition, in TwoVolumes).Washington, DC 2000.14. Lengerich EJ, Tucker T, Powell RK, et al. Cancer Incidence inKentucky, Pennsylvania, andWest Virginia: Disparities inAppalachia. J Rural Health. 2005;21(1):39-47.15. Taplin SH, Ichikawa L, Yood MU, et al. Reason for Late-Stage Breast Cancer: Absence of Screening or Detection, orBreakdown in Follow-Up? J Natl Cancer Inst.2004;96(20):1518-27.16. Lyttle NL, Stadelman K. Assessing Awareness andKnowledge of Breast and Cervical Cancer amongAppalachianWomen. Prev Chronic Dis. 2006;3(4):A125.17. Schoenberg NE, Hoopenhayn C, Christian A, et al. An In-Depth and Updated Perspective on Determinants ofCervical Cancer Screening Among Central AppalachianWomen.Women and Health. 2006;42(2):89-115.18. Stitzenberg KB, Thomas NE, Dalton K, et al. Distance toDiagnosing Provider as a Measure of Access for Patientswith Melanoma. Arch Dermatol. 2007;143(8):991-98.Information provided by theIntercultural Cancer Council713.798.4614 • 713.798.3990 (FAX)Email: icc@bcm.edu • Website: http://iccnetwork.orgCancer Fact Sheets may be downloaded in printable Adobe Portable Document Format (pdf) from:http://iccnetwork.org/cancerfacts19. Finlayson SRG. Surgery in Rural America, Surg Innov.2005;12:229–305.20. Heneghan SJ, Bordley J, Dietz PA, et al. Comparison ofUrban and Rural General Surgeons: Motivations for PracticeLocation, Practice Patterns, and Education Requirements.J Am Coll Surg. 2005; 201:732–36.21. Centers for Disease Control and Prevention. 2002 ProgramFact Sheet. Comprehensive Cancer Control. Updated 2003.Available at: http://www.cdc.gov/cancer/ncccp/about.htm.Accessed August 2011.22. Appalachian Regional Commission. 2004. Cancer Mortalityin Appalachia. An Analysis of Disparities in Health Statusand Access to Health Care in the Appalachian Region: AnARC Report. Available at: http://www.arc.gov/research/researchreportdetails.asp?REPORT_ID=82. AccessedFebruary 2011.23. Armstrong LR, Thompson T, Hall HI, Coughlin SS, Steele B,Rogers JD. Colorectal Carcinoma Mortality AmongAppalachian Men andWomen, 1969–1999. Cancer.2004;101, 2851–58.24. Bluegrass Coalition for Cancer Screening & KentuckyMedical Association Cancer Committee. Colorectal CancerFacts. J Ky Med Assoc. 2005;103,118.25. Behringer B, Friedell GH. Appalachia:Where Place Mattersin Health. Updated 2006. Available at:http://www.cdc.gov/Pcd/issues/2006/oct/06_0067.htm.Accessed February 2011.26. University of Pittsburgh Center for Rural Health Practice.Bridging the Health Divide: The Rural Public HealthResearch Agenda. 2004:16-20.27. Geller BM, Skelly JM, Dorwaldt AL, Howe KD, Dana GS,Flynn BS. Increasing Patient/Physician Communicationsabout Colorectal Cancer Screening in Rural Primary CarePractices.Medical Care. 2008;46(9):36-44.28. National Cancer Institute. Health Disparities in Cancer.Available at: http://www.cancer.gov/cancertopics/disparities. Accessed February 2011.29. Halverson JA, Ma L, Harner EJ. An Analysis of Disparities inHealth Status and Access to Health Care in the AppalachianRegion.Washington DC: Appalachian RegionalCommission.30. Wingo PA, Tucker TC, Jamison PM, et al. Cancer inAppalachia, 2001-2003. Cancer. 2008;112(1):181-92.31. Couto RA, Simpson NK, and Harris G. Sowing Seeds in theMountains: Community-Based Coalitions for CancerPrevention and Control. National Institutes of Health.National Cancer Institute; Bethesda: 2004.32. American Cancer Society. Cancer Facts and Figures. Atlanta;2005.33. Gosschalk A, Carozza S. Cancer In Rural Areas. Available at:http://www.srph.tamhsc.edu/centers/rhp2010/04Volume1cancer.pdf. Accessed February 2011.

Cancer Facts: Rural Poor

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Cancer Facts: Rural Poor

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