Cancer Risk Factors, Screening, and Neighborhood Socioeconomic Deprivation Across the U.S. Urban-to-Frontier Continuum

Abstract Background Rural U.S. populations experience higher cancer burden and lower utilization of preventive services. Heterogeneity within rural areas is poorly characterized, limiting identification of communities with the greatest needs. Methods We conducted a cross-sectional study of geographic variation in cancer-related risk behaviors and screening using tract-level Integrated Metropolitan-to-Frontier Area Codes (tIMFAC) with one urban (metropolitan) and four rural categories (micropolitan, frontier-micropolitan, small town/rural, and frontier-small town/rural). 2018 tract-level prevalences of colorectal, cervical, and breast cancer screening and risk behaviors were obtained from CDC PLACES. Demographic, neighborhood socioeconomic, and access-to-care characteristics were from the 2014–2018 American Community Survey. Adjusted mean prevalences were estimated using beta mixed-effects models with marginal standardization. Results Nonmetropolitan tracts had greater socioeconomic disadvantage, more limited healthcare access, and higher smoking, physical inactivity, and obesity prevalences than metropolitan tracts. Screening differences across tIMFAC were greater for colorectal cancer (metropolitan vs. frontier-small town/rural: 64.5% vs. 61.2%) than for cervical and breast (84.5% vs. 82.6% and 75.5% vs. 74.6%, respectively). Screening declined with increasing neighborhood deprivation, particularly for colorectal (least deprived vs. most deprived: 67.4%–69.3% vs. 55.9%–57.3%) and cervical cancer (87.1%–87.6% vs. 79.5%–80.3%). Regional variation was greater for colorectal and breast than cervical cancer screening, with higher prevalences in the Northeast and lower in the West. Conclusions tIMFAC identified screening heterogeneity not captured by traditional rural-urban classifications, particularly for colorectal cancer. Neighborhood deprivation and region contributed greater screening differences than tIMFAC alone, suggesting interventions should prioritize disadvantaged communities, particularly in the West.