One regional health system, two distinct geographic patterns in locally advanced cervical cancer: Implications for informing public health efforts for intervention (369)

Abstract

<b>Objectives:</b> Cervical cancer is preventable but remains a significant burden, with 14,480 new cases estimated in the US in 2021. Disparities in cervical cancer incidence and mortality include race/ ethnicity, socioeconomic status, and geographic location. We aimed to utilize geospatial analyses to examine patterns of cervical cancer incidence and identify populations at the highest risk, understand their unique risk factors, and use this information to inform public health efforts for intervention. <b>Methods:</b> A descriptive retrospective chart review and spatial epidemiological pilot was conducted at a regional health system in Northeast Ohio with a catchment area including rural and middlesized metropolitan/urban areas. Patients with locally advanced cervical cancer (FIGO stages IB3 - IV) diagnosed from January 2015 to March 2021 were geocoded based on their address at the time of diagnosis (<i>n</i>=165). These geocoded points were analyzed within a Geographic Information System (GIS) to identify geographic patterns, and in particular, to detect localized clusters and investigate neighborhood-level associations with social vulnerability as defined by the Center for Disease Control and Prevention Social Vulnerability Index (SVI). <b>Results:</b> Patients with locally advanced cervical cancer exhibit both clustered and dispersed patterns across the region. The two most prominent clusters were identified within specific neighborhoods in the cities of Cleveland and Elyria. In both cases, these clusters were geographically associated with areas of high SVI and a range of poor health outcomes. Additionally, there was a dispersed pattern across rural areas of the region, and these areas were associated with low SVI, meaning they were more advantaged. <b>Conclusions:</b> The two different geographic patterns, clustered in urban areas of high SVI and dispersed across rural areas of low SVI, may be indicative of inadequate access to care. That access barrier, however, may be driven by different processes based on geography and patient demographics. Additional parameters beyond SVI may be necessary to capture poverty and social disadvantage in rural areas and will be explored in subsequent studies. Identifying reasons for these two distinct geographic patterns of cervical cancer burden is the next step in this study to enable place-based interventions.