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Objectives <p>To explore the association between County Health Ranking (CHR) factors, county-level demographics, and county-level age-adjusted genitourinary (GU) cancer mortality rates.</p> Materials and Methods <p>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.</p> Results <p>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,&#xa0;<i>P</i> &lt; 0.001), positive health behaviors (− 0.58; 95% CI, − 0.83 to − 0.33,&#xa0;<i>P</i> &lt; 0.001), and clinical care (− 0.21; 95% CI, − 0.41 to − 0.01,&#xa0;<i>P</i> = 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, <i>P</i> &lt; 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, <i>P</i> = 0.01). Follow-up analysis of clinical care demonstrated that quality of care, not access, was associated with decreased mortality rates.</p> Conclusion <p>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.</p> <p><b>Classification code</b>: 9760</p>

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

  • 期刊论文

  • 发表日期：

    2025年12月4日

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  • Jad Badreddine,
  • Erin Kim,
  • Stephen Tang,
  • Stephen Rhodes,
  • Laura Davis,
  • Holly Hartman,
  • Jennifer Cullen,
  • Johnie Rose,
  • Randy Vince

摘要

Objectives

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

Materials and Methods

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.

Results

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.

Conclusion

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