One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.

Introduction: Rural populations have less access to cancer care services and experience higher cancer mortality rates than their urban counterparts, which may be exacerbated by hospital closures. Our objective was to examine the impact of hospital closures on access to cancer‐relevant hospital services across hospital service areas (HSAs).Methods: We used American Hospital Association survey data from 2008 to 2017 to examine the change in access to cancer‐related screening and treatment services across rural HSAs that sustained hospitals over time, experienced any closures, or had all hospitals close. We performed a longitudinal analysis to assess the association between hospital closure occurrence and maintenance or loss of cancer‐related service lines accounting for hospital and HSA‐level characteristics. Maps were also developed to display changes in the availability of services across HSAs.Results: Of the 2,014 rural HSAs, 3.8% experienced at least 1 hospital closure during the study period, most occurring in the South. Among HSAs that experienced hospital closure, the loss of surgery services lines was most common, while hospital closures did not affect the availability of overall oncology and radiation services. Screening services either were stable (mammography) or increased (endoscopy) in areas with no closures.Discussion: Rural areas persistently experience less access to cancer treatment services, which has been exacerbated by hospital closures. Lack of Medicaid expansion in many Southern states and other policy impacts on hospital financial viability may play a role in this. Future research should explore the impact of closures on cancer treatment receipt and outcomes.

Background/Objectives: Many social and environmental factors contribute to the disproportionate burden of COVID-19 mortality. Access to healthcare services has not been thoroughly examined as a factor contributing to COVID-19 mortality. This study examines distance to ERs and ICUs, uninsurance rates, and county-level COVID-19 mortality rates. Methods: Using data from the American Hospital Association survey, we identified hospitals providing emergency and intensive care services. Hospital locations were geocoded, and straight-line distance was calculated from the population-weighted county centroid. The county proportion of uninsured residents came from the American Community Survey. Generalized linear regression models with a log-link were used to examine study factors and county COVID-19 mortality rates. Results: A total of 2640 (84.0%) U.S. counties or county-equivalents were included in this analysis. The median COVID-19 mortality rate was 240 deaths per 100,000. In adjusted models, increasing distance to ERs (IRR: 0.95; 95% CI: 0.92, 0.98) or ICUs (IRR: 0.61; 95% CI: 0.57, 0.65) was not significantly associated with increased COVID-19 mortality. The proportion of residents (IRR: 3.81; CI: 2.58, 5.62) uninsured was significantly associated with increased COVID-19 mortality rates. Conclusions: Being in close proximity to hospital-based healthcare services may not provide any significant benefit for COVID-19 mortality outcomes, considering that hospitals are largely located in more densely populated areas conducive to COVID-19 spread. Financial barriers may largely contribute to persons avoiding necessary COVID-19 care. To continue to combat COVID-19 and future pandemics, greater attention should be focused on eliminating financial barriers to receiving medically necessary care.