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Decreased Cancer Mortality-to-Incidence Ratios with Increased Accessibility of Federally Qualified Health Centers


Federally qualified health centers (FQHCs) offer primary and preventive healthcare, including cancer screening, for the nation’s most vulnerable population. The purpose of this study was to explore the relationship between access to FQHCs and cancer mortality-to-incidence ratios (MIRs). One-way analysis of variance was conducted to compare the mean MIRs for breast, cervical, prostate, and colorectal cancers for each U.S. county for 2006–2010 by access to FQHCs (direct access, in-county FQHC; indirect access, adjacent-county FQHC; no access, no FQHC either in the county or in adjacent counties). ArcMap 10.1 software was used to map cancer MIRs and FQHC access levels. The mean MIRs for breast, cervical, and prostate cancer differed significantly across FQHC access levels (p < 0.05). In urban and healthcare professional shortage areas, mean MIRs decreased as FQHC access increased. A trend of lower breast and prostate cancer MIRs in direct access to FQHCs was found for all racial groups, but this trend was significant for whites only. States with a large proportion of rural and medically underserved areas had high mean MIRs, with correspondingly more direct FQHC access. Expanding FQHCs to more underserved areas and concentrations of disparity populations may have an important role in reducing cancer morbidity and mortality, as well as racial-ethnic disparities, in the United States.

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This publication was supported by Cooperative Agreement Number U48/DP001936 from the Centers for Disease Control and Prevention (Prevention Research Centers) and the National Cancer Institute (PIs: Dr. Hébert, Dr. Friedman). This work also was partially supported by: an Established Investigator Award in Cancer Prevention and Control from the Cancer Training Branch of the NCI to Dr. Hébert (K05 CA136975), U54 CA153461-01 from the National Cancer Institute, Center to Reduce Cancer Health Disparities (Community Networks Program) to the South Carolina Cancer Disparities Community Network-II (SCCDCN-II), and an NCI K01 Career Development Grant to Dr. Tucker-Seeley (K01 CA169041). Dr. Yip was partially supported by the National Cancer Institute (R01 CA 124397; PI: S-P Tu).

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No financial disclosures were reported by the authors of this paper.

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Correspondence to Swann Arp Adams.

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Figure S1. Access to FQHCs and colorectal cancer MIRs by region. (a) West, (b) Midwest, (c) Northeast, (d) Southwest, (e) Southeast. Supplementary material 1 (EPS 4107 kb)


Figure S2. Access to FQHCs and prostate cancer MIRs by region. (a) West, (b) Midwest, (c) Northeast, (d) Southwest, (e) Southeast. Supplementary material 2 (EPS 4107 kb)

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Adams, S.A., Choi, S.K., Khang, L. et al. Decreased Cancer Mortality-to-Incidence Ratios with Increased Accessibility of Federally Qualified Health Centers. J Community Health 40, 633–641 (2015).

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  • Cancer
  • Community health centers
  • Medically underserved areas
  • African Americans
  • Health care disparity