This work was supported in part by National Institutes of Health Grant Number 1P20RR018787; and by the Agency for Healthcare Research and Quality under Ruth L. Kirschstein National Research Service Award no. T32HS000070. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, National Cancer Institute; the Office of Research, Development and Information, Centers for Medicare & Medicaid Services; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.They would like to thank Dan Gottlieb, MS, for his invaluable assistance with creation of the analytic dataset and keen advice. For further information, contact: Tracy Onega, PhD, Department of Community and Family Medicine, Dartmouth Medical School, HB 7927, Rubin Building, 8th Floor, One Medical Center Drive, Lebanon, NH 03756; e-mail Tracy.L.Onega@dartmouth.edu.
Influence of Place of Residence in Access to Specialized Cancer Care for African Americans
Article first published online: 4 JAN 2010
© 2010 National Rural Health Association
The Journal of Rural Health
Volume 26, Issue 1, pages 12–19, Winter 2010
How to Cite
Onega, T., Duell, E. J., Shi, X., Demidenko, E. and Goodman, D. (2010), Influence of Place of Residence in Access to Specialized Cancer Care for African Americans. The Journal of Rural Health, 26: 12–19. doi: 10.1111/j.1748-0361.2009.00260.x
- Issue published online: 4 JAN 2010
- Article first published online: 4 JAN 2010
- Access to health care;
- African Americans;
- cancer care facilities;
- health services accessibility;
- rural health services
Context: Disparities in cancer care for rural residents and for African Americans have been documented, but the interaction of these factors is not well understood.
Purpose: The authors examined the simultaneous influence of race and place of residence on access to and utilization of specialized cancer care in the United States.
Methods: Access to specialized cancer care was measured using: (1) travel time to National Cancer Institute (NCI) Cancer Centers, academic medical centers, and any oncologist for the entire continental US population, and (2) per capita availability of oncologists for the entire United States. Utilization was measured as attendance at NCI Cancer Centers, specialized hospitals, and other hospitals in the Surveillance, Epidemiology, and End Results (SEER) program Medicare population from 1998-2004.
Findings: In urban settings, travel times were shorter for African Americans compared with Caucasians for all three cancer care settings, but they were longer for rural African Americans traveling to NCI Cancer Centers. Per capita oncologist availability was not significantly different by race or place of residence. Urban African American patients were almost 70% more likely to attend an NCI Cancer Center than urban Caucasian patients (OR = 1.66; 95% CI 1.51-1.83), whereas rural African American patients were 58% less likely to attend an NCI Cancer Center than rural Caucasian patients (OR = 0.42; 95% CI 0.26-0.66).
Conclusions: Urban African Americans have similar or better access to specialized cancer care than urban Caucasians, but rural African Americans have relatively poor access and lower utilization compared with all other groups.