For many cancer types, cancer incidence and mortality disproportionately affect rural populations.^1,2 When compared with residents in urban areas, individuals in rural areas have an increased risk of cancer incidence and mortality of 2.7% and 9.6%, respectively.¹ While the overall national cancer incidence has declined, a rural-urban disparity in cancer mortality has persisted for lung, prostate, breast, and colorectal cancers.^1,3 Interest has increased in characterizing cancer disease burden between rural and urban areas across the cancer continuum; yet, most of these observations focus solely on cancer incidence and mortality outcomes and not survivorship. As a population-based indicator, survival rates report the elapsed time to death and illuminate advancements in and access to screening, treatment technologies, and quality clinical care.⁴ Cancer survival rates should be understood in the context of cancer burden. However, reports on potential rural-urban disparities in survival rates remain a gap in the literature. To date, no studies have reported on the trends in survival for cancer types that have higher rates of incidence and mortality for rural residents.

Rural residents in underserved areas face many barriers to health services, including colonoscopies for colorectal cancer (CRC) screening, but rural healthcare providers may assist patients navigating these challenges due to familiarity with local contexts. In 2017 to 2018, we interviewed clinical practitioners and staff (n = 40) at 13 primary care and gastroenterology locations across rural Southern Illinois. We used a semi-structured interview guide that addressed system, provider, and patient levels including domains related to barriers, facilitators, and needs for intervention. This article focuses on 3 main elements related to distance and transportation that emerged from inductive coding. First, providers described long distance travel for care as normalized but not necessarily preferable. Second, they identified and described distance-related challenges specific to CRC screening, and third, providers discussed strategies, mostly related to transportation, they use to navigate those challenges. Finally, they suggested a variety of broader solutions to reduce distance and transportation barriers to screening. Overall, distance to care remains a challenge to increasing CRC screening and contributes to disparities in rural communities. To increase early detection and reduce rural cancer disparities, efforts to increase screening and follow-up must address ways to help patients and providers navigate this distance within their local communities and contexts.

INTRODUCTION: Social determinants of health (SDOH) may impact chronic liver disease (CLD) outcomes but are not clearly understood. We conducted a systematic review to describe the associations of SDOH with mortality, hospitalizations, and readmissions among patients with CLD. METHODS: This review was registered (PROSPERO ID: CRD42022346654) and identified articles through MEDLINE, Embase, Cochrane Library, and Scopus databases. The review included studies that reported SDOH characteristics within the domains of economic stability, healthcare access, education, social and community context, and the neighborhood-built environment. Associated outcomes of interest were mortality, hospitalizations, or readmissions. The Cochrane Risk of Bias in Nonrandomized Studies for Exposure was used to assess study quality and risk of bias. RESULTS: A total of 5,205 abstracts were screened, 60 articles underwent full-text review, and 27 articles were included in the final review. Poor economic stability, healthcare access, social support, and household/environmental conditions were associated with higher mortality and hospital readmissions among patients with CLD. Increasing distance (≥25 miles away) from a liver transplantation center was associated with higher mortality, despite increasing access to the liver transplantation waitlist. When assessing the overall risk of bias among included studies, most had “some concern” (N = 13, 48.1%) or “high risk” (N = 11, 40.7%), whereas a minority had “very high risk” (N = 3, 11.1%). No studies were categorized as “low risk.” DISCUSSION: Unfavorable SDOH were associated with increased mortality and hospital readmissions among patients with CLD. Rigorous empirical research is needed to identify evidence-based strategies that aim to mitigate disparities among vulnerable populations.

Background: Structural inequities, in part, undergird urban–rural differences in cancer care. The current study aims to understand the potential consequences of structural inequities on rural and urban cancer patients’ access to and perceived importance of supportive cancer care resources. Methods: We used data collected from November 2017 to May 2018 from a larger cross-sectional needs assessment about patients’ support needs, use of services, and perceptions at a Midwestern United States cancer center. Oncology patients received a study packet during their outpatient clinic visit, and interested patients consented and completed the questionnaires. Results: Among the sample of 326 patients, 27% of the sample was rural. In adjusted logistic regression models, rural patients were less likely to report using any secondary support services (15% vs. 27%; OR = 0.43, 95%CI [0.22, 0.85], p = 0.02) and less likely than urban counterparts to perceive secondary support services as very important (51% vs. 64%; OR = 0.57, 95%CI [0.33, 0.94], p = 0.03). Conclusion: Structural inequities likely have implications on the reduced access to and importance of supportive care services observed for rural cancer patients. To eliminate persistent urban–rural disparities in cancer care, rural residents must have programs and policies that address cancer care and structural inequities.