Association between County Health Rankings Factors and County-level Genitourinary Cancer Mortality

To explore the association between County Health Ranking (CHR) factors, county-level demographics, and county-level age-adjusted genitourinary (GU) cancer mortality rates.

This population-based study used county-level data from the US and CHR program. CHR bases county-level scoring on four factors: health behaviors, clinical care, social and economic factors, and physical environment-higher values per factor signify a better score. The relationship between county-level factors, demographics, and age-adjusted GU-cancer mortality rates was analyzed with linear mixed-effects models. We included interaction terms between the county-level factors and the proportion of Black residents.

County-level variables associated with lower age-adjusted GU-cancer mortality rates included larger population (beta/SD increase: - 0.64; 95% CI, - 0.82 to - 0.4, P < 0.001), positive health behaviors (- 0.58; 95% CI, - 0.83 to - 0.33, P < 0.001), and clinical care (- 0.21; 95% CI, - 0.41 to - 0.01, P = 0.04). A higher proportion of Black residents was associated with increasing age-adjusted GU-cancer mortality rate (0.52; 95% CI, 0.28-0.75, P < 0.001). Interaction terms demonstrated a relationship between clinical care and age-adjusted GU-cancer mortality rates that was attenuated by the proportion of Black residents (interaction-beta: 0.24; 95% CI, 0.06-0.42, P = 0.01). Follow-up analysis of clinical care demonstrated that quality of care, not access, was associated with decreased mortality rates.

The beneficial association between better clinical care and decreased age-adjusted GU-cancer mortality rates was modulated by the proportion of Black residents and appears due to the healthcare access sub-component. These findings suggest that having healthcare resources within a county does not ensure equitable access to high-quality healthcare, specifically for Black residents. Classification code: 9760.