{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T19:27:20Z","timestamp":1793906840640,"version":"4.8.0"},"reference-count":50,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Cancer screening, prevalence, and mortality vary across US counties; the broad set of community factors associated with these differences are not well understood.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the relative importance of diverse community measures for explaining county-level variance in cancer screening, prevalence, and mortality rates for breast, colorectal, lung, and prostate cancers.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This geospatial cross-sectional analysis across all US counties used random forest algorithms to estimate the relative importance of 24 community measures\u2014including health behaviors and lifestyle, socioeconomic, and environment factors\u2014as explanatory factors for cancer screening, prevalence, and mortality. For each cancer, county-level cancer screening and prevalence rates were based on a nationally representative 5% sample of Medicare fee-for-service beneficiaries (2020). The 5-year (2016-2020) mean mortality rates were from the National Cancer Institute\u2019s State Cancer Profiles. Neiman Cancer disparity maps geospatially display significant community-factor to cancer-outcome associations via county-level choropleth maps. Data were analyzed from September 2024 through February 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Residence in the 50 states, Puerto Rico, and the District of Columbia.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Outcomes were county-level rates of cancer screening, prevalence, and mortality for breast, colorectal, lung, and prostate cancers. Separate random forest algorithms estimated the relative importance of 24 community measures for each outcome\u2013cancer type combination, and maps display county-level associations.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among a nationally representative 5% of 2020 Medicare Fee-For-Service beneficiaries, 87% were aged 65 years or older. The top ranking explanatory community factors (100% relative importance) for mortality were smoking rate for both lung and colorectal cancers, and the non-Hispanic Black population share for both breast and prostate cancers. For prevalence and screening rates, the top factors were unique for each cancer type. Uninsured rate, unemployment, limited access to health foods, and poor physical health were the top ranked factors for breast, colorectal, lung, and prostate cancer prevalence, respectively. Hispanic population, poverty, air pollution, and Air Toxics Cancer Risk were ranked highest for screening rates, respectively, for each cancer. Two of only 3 environmental factors, Environmental Justice Index and Air Toxics Cancer Risk, had the most top-5 associations for mortality and screening, respectively. Uninsured rates for prevalence and poverty rates for screening were also important across cancer types.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study of the relative explanatory importance of community measures on cancer screening, prevalence, and mortality rate we found that the ranking of factors varied for each specific cancer and outcome, which can inform targeted population health efforts. Factors that ranked high across cancer types for a given outcome, such as uninsured rates for cancer prevalence, represent opportune targets for future study and broader policy change.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.37690","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T15:31:00Z","timestamp":1761233460000},"page":"e2537690","source":"Crossref","is-referenced-by-count":6,"title":["Community Factors and County-Level Cancer Screening, Prevalence, and Mortality"],"prefix":"10.1001","volume":"8","author":[{"given":"Alexandra R.","family":"Drake","sequence":"first","affiliation":[{"name":"Harvey L. Neiman Health Policy Institute, Reston, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric W.","family":"Christensen","sequence":"additional","affiliation":[{"name":"Harvey L. Neiman Health Policy Institute, Reston, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augusto C.","family":"Ochoa","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Oncology, Louisiana State University Health Sciences Center, New Orleans"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"William","family":"Small","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernadin Cancer Center, Loyola University Chicago, Maywood, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinel","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Radiology, State University of New York Downstate Health Sciences University, Brooklyn"},{"name":"Office of Quality and Safety, New York City Health and Hospitals\/Kings, Brooklyn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth Y.","family":"Rula","sequence":"additional","affiliation":[{"name":"Harvey L. Neiman Health Policy Institute, Reston, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"issue":"7","key":"zoi251043r2","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1158\/1055-9965.EPI-19-1534","article-title":"Medical care costs associated with cancer survivorship in the United States.","volume":"29","author":"Mariotto","year":"2020","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"12","key":"zoi251043r3","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1093\/jnci\/djab192","article-title":"Annual report to the nation on the status of cancer, part 2: patient economic burden associated with cancer care.","volume":"113","author":"Yabroff","year":"2021","journal-title":"J Natl Cancer Inst"},{"issue":"2","key":"zoi251043r5","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.amepre.2015.08.024","article-title":"County health rankings: relationships between determinant factors and health outcomes.","volume":"50","author":"Hood","year":"2016","journal-title":"Am J Prev Med"},{"key":"zoi251043r6","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1186\/s12913-015-1053-3","article-title":"A cross-sectional study on health differences between rural and non-rural U.S. counties using the County Health Rankings.","volume":"15","author":"Anderson","year":"2015","journal-title":"BMC Health Serv Res"},{"issue":"2","key":"zoi251043r7","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1377\/hlthaff.21.2.78","article-title":"The case for more active policy attention to health promotion.","volume":"21","author":"McGinnis","year":"2002","journal-title":"Health Aff (Millwood)"},{"issue":"6","key":"zoi251043r8","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1016\/j.amepre.2015.07.016","article-title":"Relative contributions of a set of health factors to selected health outcomes.","volume":"49","author":"Park","year":"2015","journal-title":"Am J Prev Med"},{"issue":"14","key":"zoi251043r9","doi-asserted-by":"publisher","first-page":"1444","DOI":"10.1001\/jama.2018.0158","article-title":"The state of US health, 1990-2016: burden of diseases, injuries, and risk factors among US states.","volume":"319","author":"US Burden of Disease Collaborators","year":"2018","journal-title":"JAMA"},{"issue":"9","key":"zoi251043r10","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1007\/s10654-018-0374-z","article-title":"Lifestyle factors, cardiovascular disease and all-cause mortality in middle-aged and elderly women: a systematic review and meta-analysis.","volume":"33","author":"Colpani","year":"2018","journal-title":"Eur J Epidemiol"},{"key":"zoi251043r11","doi-asserted-by":"publisher","DOI":"10.1177\/00333549141291S206","article-title":"The social determinants of health: it\u2019s time to consider the causes of the causes.","author":"Braveman","year":"2014","journal-title":"Public Health Rep"},{"issue":"1","key":"zoi251043r12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jhealeco.2007.03.001","article-title":"Mortality, lifestyle and socio-economic status.","volume":"27","author":"Balia","year":"2008","journal-title":"J Health Econ"},{"issue":"3","key":"zoi251043r13","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.ypmed.2012.06.017","article-title":"The combined effects of healthy lifestyle behaviors on all cause mortality: a systematic review and meta-analysis.","volume":"55","author":"Loef","year":"2012","journal-title":"Prev Med"},{"issue":"18","key":"zoi251043r14","doi-asserted-by":"publisher","first-page":"2207","DOI":"10.1001\/jama.1993.03510180077038","article-title":"Actual causes of death in the United States.","volume":"270","author":"McGinnis","year":"1993","journal-title":"JAMA"},{"key":"zoi251043r15","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1146\/annurev-publhealth-031210-101218","article-title":"The social determinants of health: coming of age.","volume":"32","author":"Braveman","year":"2011","journal-title":"Annu Rev Public Health"},{"issue":"3","key":"zoi251043r16","article-title":"Response to: local social vulnerability as a predictor for cancer-related mortality among US counties.","volume":"30","author":"Chen","year":"2025","journal-title":"Oncologist"},{"issue":"12","key":"zoi251043r17","doi-asserted-by":"publisher","first-page":"DS43","DOI":"10.1097\/00005650-199512001-00007","article-title":"Socioeconomic status and the health of the population.","volume":"33","author":"Mustard","year":"1995","journal-title":"Med Care"},{"issue":"21","key":"zoi251043r18","doi-asserted-by":"publisher","first-page":"1703","DOI":"10.1001\/jama.279.21.1703","article-title":"Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults.","volume":"279","author":"Lantz","year":"1998","journal-title":"JAMA"},{"issue":"5","key":"zoi251043r19","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1007\/s10900-017-0327-6","article-title":"Neighborhood socioeconomic status and health: a longitudinal analysis.","volume":"42","author":"Robinette","year":"2017","journal-title":"J Community Health"},{"issue":"8","key":"zoi251043r20","doi-asserted-by":"publisher","first-page":"1456","DOI":"10.2105\/AJPH.2010.300086","article-title":"Estimated deaths attributable to social factors in the United States.","volume":"101","author":"Galea","year":"2011","journal-title":"Am J Public Health"},{"issue":"1","key":"zoi251043r21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.amepre.2007.09.017","article-title":"Mortality from leading causes by education and race in the United States, 2001.","volume":"34","author":"Jemal","year":"2008","journal-title":"Am J Prev Med"},{"issue":"10","key":"zoi251043r22","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.40467","article-title":"Social determinants of health and US health care expenditures by insurer.","volume":"7","author":"Mohan","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"88","key":"zoi251043r23","first-page":"1","article-title":"75 years of mortality in the United States, 1935-2010.","author":"Hoyert","year":"2012","journal-title":"NCHS Data Brief"},{"issue":"395","key":"zoi251043r24","first-page":"1","article-title":"Mortality in the United States, 2019.","author":"Kochanek","year":"2020","journal-title":"NCHS Data Brief"},{"issue":"2","key":"zoi251043r25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss7302a1","article-title":"Preventable premature deaths from the five leading causes of death in nonmetropolitan and metropolitan counties, United States, 2010-2022.","volume":"73","author":"Garcia","year":"2024","journal-title":"MMWR Surveill Summ"},{"issue":"19","key":"zoi251043r30","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.1001\/jama.2021.6238","article-title":"Screening for colorectal cancer: US Preventive Services Task Force recommendation statement.","volume":"325","author":"US Preventive Services Task Force","year":"2021","journal-title":"JAMA"},{"issue":"18","key":"zoi251043r31","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.1001\/jama.2018.3710","article-title":"Screening for prostate cancer: US Preventive Services Task Force recommendation statement.","volume":"319","author":"US Preventive Services Task Force","year":"2018","journal-title":"JAMA"},{"issue":"10","key":"zoi251043r32","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1001\/jama.2021.1117","article-title":"Screening for lung cancer: US Preventive Services Task Force recommendation statement.","volume":"325","author":"US Preventive Services Task Force","year":"2021","journal-title":"JAMA"},{"issue":"22","key":"zoi251043r33","doi-asserted-by":"publisher","first-page":"1918","DOI":"10.1001\/jama.2024.5534","article-title":"Screening for breast cancer: US Preventive Services Task Force recommendation statement.","volume":"331","author":"US Preventive Services Task Force","year":"2024","journal-title":"JAMA"},{"issue":"1","key":"zoi251043r35","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1177\/1536867X20909688","article-title":"The random forest algorithm for statistical learning.","volume":"20","author":"Schonlau","year":"2020","journal-title":"Stata J"},{"issue":"30","key":"zoi251043r36","doi-asserted-by":"publisher","first-page":"3618","DOI":"10.1200\/JCO.23.02780","article-title":"Social genomic determinants of health: understanding the molecular pathways by which neighborhood disadvantage affects cancer outcomes.","volume":"42","author":"Goel","year":"2024","journal-title":"J Clin Oncol"},{"issue":"9","key":"zoi251043r37","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.30925","article-title":"Variation in and factors associated with US county-level cancer mortality, 2008-2019.","volume":"5","author":"Dong","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"2","key":"zoi251043r38","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1093\/jnci\/djh014","article-title":"Tobacco and cancer: recent epidemiological evidence.","volume":"96","author":"Vineis","year":"2004","journal-title":"J Natl Cancer Inst"},{"issue":"2","key":"zoi251043r39","doi-asserted-by":"publisher","first-page":"R42","DOI":"10.1186\/bcr3646","article-title":"Smoking at time of diagnosis and breast cancer-specific survival: new findings and systematic review with meta-analysis.","volume":"16","author":"Berube","year":"2014","journal-title":"Breast Cancer Res"},{"key":"zoi251043r41","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.sleep.2016.06.036","article-title":"Sleep duration and total cancer mortality: a meta-analysis of prospective studies.","volume":"27-28","author":"Ma","year":"2016","journal-title":"Sleep Med"},{"key":"zoi251043r42","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2020.101409","article-title":"Sleep disorders and cancer: state of the art and future perspectives.","volume":"56","author":"Mogavero","year":"2021","journal-title":"Sleep Med Rev"},{"issue":"23","key":"zoi251043r43","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph192315542","article-title":"Overcrowding and hazardous dwelling condition characteristics: a systematic search and scoping review of relevance for health.","volume":"19","author":"Lorentzen","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"179","key":"zoi251043r44","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.24976\/Discov.Med.202335179.114","article-title":"Association between urinary lead and female breast cancer: a population-based cross-sectional study.","volume":"35","author":"Hu","year":"2023","journal-title":"Discov Med"},{"issue":"7","key":"zoi251043r45","doi-asserted-by":"publisher","first-page":"540","DOI":"10.5271\/sjweh.4046","article-title":"Lung cancer incidence among workers biologically monitored for occupational exposure to lead: a cohort study.","volume":"48","author":"Anttila","year":"2022","journal-title":"Scand J Work Environ Health"},{"issue":"159","key":"zoi251043r46","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0230-2020","article-title":"Systematic review and meta-analysis of residential radon and lung cancer in never-smokers.","volume":"30","author":"Cheng","year":"2021","journal-title":"Eur Respir Rev"},{"issue":"10","key":"zoi251043r47","doi-asserted-by":"publisher","first-page":"1162","DOI":"10.1001\/jamainternmed.2023.2835","article-title":"Association of neighborhood-level environmental injustice with health status in the US.","volume":"183","author":"Patel","year":"2023","journal-title":"JAMA Intern Med"},{"issue":"6","key":"zoi251043r48","doi-asserted-by":"publisher","first-page":"524","DOI":"10.3322\/caac.21754","article-title":"Breast cancer statistics, 2022.","volume":"72","author":"Giaquinto","year":"2022","journal-title":"CA Cancer J Clin"},{"issue":"6","key":"zoi251043r49","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1001\/archfami.8.6.521","article-title":"Breast cancer trends of black women compared with white women.","volume":"8","author":"Chu","year":"1999","journal-title":"Arch Fam Med"},{"key":"zoi251043r50","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.102138","article-title":"Racial\/ethnic disparities in the cause of death among patients with prostate cancer in the United States from 1995 to 2019: a population-based retrospective cohort study.","volume":"62","author":"Zeng","year":"2023","journal-title":"EClinicalMedicine"},{"key":"zoi251043r1","unstructured":"National Cancer Institute. Cancer statistics. Accessed March 6, 2025. https:\/\/www.cancer.gov\/about-cancer\/understanding\/statistics"},{"key":"zoi251043r4","unstructured":"University of Wisconsin Population Health Institute. County health rankings and roadmaps. Accessed July 1, 2025. http:\/\/www.countyhealthrankings.org"},{"key":"zoi251043r26","unstructured":"National Cancer Institute. Cancer stat facts: common cancer sites. Accessed March 6, 2025. https:\/\/seer.cancer.gov\/statfacts\/html\/common.html"},{"key":"zoi251043r27","unstructured":"Harvey? L. Cancer disparity maps. Neiman Health Policy Institute. Accessed March 6, 2025. https:\/\/www.neimanhpi.org\/cancer-disparity-maps\/"},{"key":"zoi251043r28","unstructured":"American Cancer Society. American Cancer Society guidelines for the early detection of cancer. Updated November 1, 2023. Accessed July 1, 2025. https:\/\/www.cancer.org\/cancer\/screening\/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html"},{"key":"zoi251043r29","unstructured":"US Preventive Services Task Force. Screening recommendations. Accessed June 18, 2025. https:\/\/www.uspreventiveservicestaskforce.org\/uspstf\/topic_search_results?topic_status=P&category%5B%5D=15&type%5B%5D=5&searchterm="},{"key":"zoi251043r34","unstructured":"Health Resources and Services Administration. Area health resource files. Accessed April 1, 2024. https:\/\/data.hrsa.gov\/topics\/health-workforce\/ahrf"},{"key":"zoi251043r40","unstructured":"Centers for Disease Control and Prevention. Lung cancer risk factors. Accessed November 19, 2024. https:\/\/www.cdc.gov\/lung-cancer\/risk-factors\/index.html"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2840494\/drake_2025_oi_251043_1760640349.90383.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T15:31:05Z","timestamp":1761233465000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2840494"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,23]]},"references-count":50,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.37690","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,23]]}}}