Cancer Risk Factors and Rurality

The purpose of this analysis is to compare the incidence of cancer-related to risk factors and geographic characteristics such as access and use of preventative care, uninsured rates, smoking rates, access to broadband internet, race, and rurality for each county and state.

For the period 2007-2017 rural death rates were higher than urban rates for the seven major causes of death analyzed including, congestive heart failure, stroke, cancer, diabetes, unintentional injury, suicide, and chronic obstructive pulmonary diseases (COPD) (Yaemsiri et al., 2019). Cancer patients in rural areas often have to travel significant distances to obtain the care they require and are less likely to be recruited into clinical trials (Zahnd & Ganai, 2019). One solution to support sustainable care for cancer survivors in rural areas once their treatment has concluded is through telehealth either in the person’s home or at a telehealth community site (DeGuzman et al., 2020). However, limits to broadband internet access in rural areas can disrupt the ability of cancer survivors to receive telehealth services (DeGuzman et al., 2020). Other factors can also impact the survivorship of cancer patients including financial hardship, race, and health behaviors (Hastert et al., 2019).

Analyzing the Data

This data represents the most current publicly available information sources that are commonly used to study health care trends. The data is derived from the Data Sources listed below and combined to support the analysis.

This data is also available in a text-based table format.

Tutorial: Using the Data

Data Sources

CDC PLACES Data (data released March 2021)

County Health Ranking (data released 2021)

Defining the Columns

A blank entry indicates unreported data. A value of zero is a defined value and does not represent unreported data.

State: The abbreviation of the state.

County: The name of the county. County names are listed as provided on the U.S. Census Bureau's list of 2020 FIPS Codes for Counties and County Equivalent Entities.

Geography: Based on the Core Based Statistical Areas include Metropolitan and Micropolitan Statistical Areas. 

  • Rural: areas that have a population of fewer than 10,000.
  • Metropolitan: areas that have at least one urbanized area of 50,000 or more population, plus adjacent territory that has a high degree of social and economic integration with the core as measured by commuting ties.
  • Micropolitan: areas that have at least one urban cluster of at least 10,000 but less than 50,000 population, plus adjacent territory that has a high degree of social and economic integration with the core as measured by commuting ties.

Primary Care HPSA: A county that is considered to have a shortage in health professionals including doctors of medicine (M.D.) and doctors of osteopathy (D.O.) providing direct patient care who practice principally in one of the four primary care specialties: general or family practice, general internal medicine, pediatrics, and obstetrics and gynecology. This variable has three possible values:

  • None = None of the county designated as a shortage area
  • Partial = The whole county designated as a shortage area
  • Whole = One or more parts of the county designated as a shortage area

Percent Cancer: Percentage of respondents aged ≥18 years who report ever having been told by a doctor, nurse, or other health professionals that they have cancer, besides skin cancer. The measure is provided by the Behavioral Risk Factor Surveillance System (BRFSS) survey. Data is only provided for counties with more than 50 respondents to the BRFSS survey and is from 2018.

Percent Smoking: Percentage of respondents aged ≥18 years who report having smoked ≥100 cigarettes in their lifetime and currently smoke every day or some days. The measure is provided by the Behavioral Risk Factor Surveillance System (BRFSS) survey. Data is only provided for counties with more than 50 respondents to the BRFSS survey and is from 2018.

Visits to Doctor: Percentage of respondents aged ≥18 years who report having been to a doctor for a routine checkup (e.g., a general physical exam, not an exam for a specific injury, illness, condition) in the previous year. The measure is provided by the Behavioral Risk Factor Surveillance System (BRFSS) survey. Data is only provided for counties with more than 50 respondents to the BRFSS survey and is from 2018.

Access to Broadband: Percentage of households with a broadband internet connection (e.g., cable, DSL, fiber-optic, cell phone, or satellite) through a subscription. The measure is provided by the American Community Survey (ACS) and includes data collected between 2015 and 2019. 

Percent Men Preventative Screenings: Percentage of men aged ≥65 years reporting having received all of the following: an influenza vaccination in the past year; a pneumococcal vaccination (PPV) ever; and either a fecal occult blood test (FOBT) within the past year, a sigmoidoscopy within the past 5 years and an FOBT within the past 3 years, or a colonoscopy within the past 10 years. The measure is provided by the Behavioral Risk Factor Surveillance System (BRFSS) survey. Data is only provided for counties with more than 50 respondents to the BRFSS survey and is from 2018.

Percent Women Preventative Screenings: Percentage of women aged ≥65 years reporting having received all of the following: an influenza vaccination in the past year; a pneumococcal vaccination (PPV) ever; either a fecal occult blood test (FOBT) within the past year, a sigmoidoscopy within the past 5 years and an FOBT within the past 3 years, or a colonoscopy within the previous 10 years; and a mammogram in the past 2 years. The measure is provided by the Behavioral Risk Factor Surveillance System (BRFSS) survey. Data is only provided for counties with more than 50 respondents to the BRFSS survey and is from 2018.

Percent Uninsured: Percentage of people under age 65 without insurance. The data is derived from the Small Area Health Insurance Estimates (SAHIE) program from 2018.

Primary Care Physicians: The number of primary care providers per 100,000 population. The data is derived from the Small Area Resource File and the American Medical Association from 2019.

Percent Asian: The proportion of the county’s population that falls into the racial or ethnic category of Asian from the U.S. Census Bureau Population Estimates from 2019.

Percent Black: The proportion of the county’s population that falls into the racial or ethnic category of Black from the U.S. Census Bureau Population Estimates from 2019.

Percent Hispanic: The proportion of the county’s population that falls into the racial or ethnic category of Hispanic from the U.S. Census Bureau Population Estimates from 20198.

Percent Native Hawaiian or Other Pacific Islander: The proportion of the county’s population that falls into the racial or ethnic category of Native Hawaiian or Other Pacific Islander from the U.S. Census Bureau Population Estimates from 2019.

Percent Native American: The proportion of the county’s population that falls into the racial or ethnic category of Native American from the U.S. Census Bureau Population Estimates from 2019.

Percent White: The proportion of the county’s population that falls into the racial or ethnic category of White from the U.S. Census Bureau Population Estimates from 2019.

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,560,000 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.