Residents of U.S. rural areas continue to have an elevated risk of skin cancer compared to their urban counterparts, and these differences are amplified among patients with skin of colour, researchers report in the Journal of Drugs in Dermatology (June 2024; 23(6):480).
In the paper, the authors explain that while urban-rural health disparities in skin cancer prognosis have been well-described in the literature, few studies have evaluated the role of social determinants of health in these disparities. Fewer still have investigated how these disparities impact patients with skin of colour.
This cross-sectional study evaluates these relationships, using data from five U.S. states using the 2018 to 2021 Behavior Risk Factor Surveillance Survey, a national state-run health survey.
Researchers evaluated the prevalence of skin cancer history and urban/rural status across several social determinants of health, including sex, age, race, insurance status, number of personal healthcare providers, and household income.
They found rural residents were significantly more likely to have a positive skin cancer history across most social determinants of health compared to urban residents. Rural populations had a higher prevalence of skin cancer history across all races (p<0.001). Rural non-Hispanic Whites had greater odds than their urban counterparts (OR=1.40; 95% CI 1.34 - 1.46). The odds were approximately twice as high for rural Black (OR=1.74; 95% CI 1.14 - 2.65), Hispanic (OR=2.31; 95% CI 1.56 - 3.41), and Other Race, non-Hispanic (OR=1.99; 95% CI 1.51 - 2.61), and twenty times higher for Asians (OR=20.46; 95% CI 8.63 - 48.54), although no significant difference was seen for American Indian/Alaskan Native (OR=1.5; 95% CI 0.99 - 2.28).
The authors found no significant difference in prevalence or odds ratio between urban and rural settings when household income exceeded $100,000.
In their conclusion, the authors write, “Despite increasing awareness of metropolitan-based health inequity, urban-rural disparities in skin cancer prevalence continue to persist and may be magnified by social determinants such as income and race.”
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