{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:59:40Z","timestamp":1791478780887,"version":"4.3.4"},"reference-count":39,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["1R21MD018641"],"award-info":[{"award-number":["1R21MD018641"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]},{"award":["1R21MD018641"],"award-info":[{"award-number":["1R21MD018641"]}],"id":[{"id":"https:\/\/ror.org\/0493hgw16","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30 CA086862-25S2"],"award-info":[{"award-number":["P30 CA086862-25S2"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30CA118100"],"award-info":[{"award-number":["P30CA118100"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["Contract HHSN261201800014I, Task Order HHSN26100001"],"award-info":[{"award-number":["Contract HHSN261201800014I, Task Order HHSN26100001"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30 CA086862"],"award-info":[{"award-number":["P30 CA086862"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["NIH K00CA253685"],"award-info":[{"award-number":["NIH K00CA253685"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"award":["P30 CA086862-25S2"],"award-info":[{"award-number":["P30 CA086862-25S2"]}],"id":[{"id":"https:\/\/ror.org\/040gcmg81","id-type":"ROR","asserted-by":"publisher"}]},{"award":["P30CA118100"],"award-info":[{"award-number":["P30CA118100"]}],"id":[{"id":"https:\/\/ror.org\/040gcmg81","id-type":"ROR","asserted-by":"publisher"}]},{"award":["Contract HHSN261201800014I, Task Order HHSN26100001"],"award-info":[{"award-number":["Contract HHSN261201800014I, Task Order HHSN26100001"]}],"id":[{"id":"https:\/\/ror.org\/040gcmg81","id-type":"ROR","asserted-by":"publisher"}]},{"award":["P30 CA086862"],"award-info":[{"award-number":["P30 CA086862"]}],"id":[{"id":"https:\/\/ror.org\/040gcmg81","id-type":"ROR","asserted-by":"publisher"}]},{"award":["NIH K00CA253685"],"award-info":[{"award-number":["NIH K00CA253685"]}],"id":[{"id":"https:\/\/ror.org\/040gcmg81","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Purpose: Purchased\/Referred Care Delivery Area (PRCDA) counties are those where resident American Indian and Alaska Native (AIAN) people are eligible for Indian Health Service care. Due to concerns about racial misclassification, cancer statistics for AIAN people are often restricted to PRCDA counties. Differences in sociodemographic characteristics may exist between PRCDA and non-PRCDA counties, but have not been described; therefore, the potential selection bias associated with the restriction to PRCDA counties remains unknown. Methods: We used data from the University of California, San Francisco Health Atlas to explore ecological differences in county-level demographic, socioeconomic, healthcare access, and health outcomes data between PRCDA and non-PRCDA counties (n = 3152 counties). We tested for statistical differences in mean levels of demographics between PRCDA and non-PRCDA counties using Pooled or Welch t-tests. Results: We observed small, but statistically significant differences between PRCDA and non-PRCDA counties in county-level demographic and socioeconomic characteristics (age, poverty, utility services threat, unemployment, educational attainment, computer access, and median income), neighborhood and environment characteristics (overcrowding, severe mortgage\/rent burden), healthcare access and utilization (uninsured, annual checkup, annual dental visit, mammography, binge drinking, smoking, physical inactivity, social isolation), and health outcomes (poor mental health, arthritis, poor self-rated health, high blood pressure, diabetes, high cholesterol, and obesity). Conclusions: These results indicate variability in county-level measures between PRCDA and non-PRCDA counties. While these data do not speak specifically to AIAN peoples\u2019 experiences, they provide critical contextual information to understand how exclusion of AIAN people residing in non-PRCDA counties from cancer statistics may bias risk estimates.<\/jats:p>","DOI":"10.3390\/ijerph23050622","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T20:11:13Z","timestamp":1778271073000},"page":"622","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Area-Level Sociodemographic Differences Between Indian Health Service Purchased\/Referred and Non-Purchased\/Referred Care Delivery Areas"],"prefix":"10.3390","volume":"23","author":[{"given":"Sarah H.","family":"Nash","sequence":"first","affiliation":[{"name":"Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA"},{"name":"Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA"},{"name":"University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA"},{"name":"Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2856-7108","authenticated-orcid":false,"given":"Rachael","family":"Adcock","sequence":"additional","affiliation":[{"name":"University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA"},{"name":"Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7198-7629","authenticated-orcid":false,"given":"Mindy C.","family":"Hebert-DeRouen","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, New Mexico State University, Las Cruces, NM 88003, USA"},{"name":"Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5304-4336","authenticated-orcid":false,"given":"Natalie S.","family":"Joe","sequence":"additional","affiliation":[{"name":"Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20850, USA"},{"name":"Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20850, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7885-5004","authenticated-orcid":false,"given":"Dornell","family":"Pete","sequence":"additional","affiliation":[{"name":"Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler B.","family":"Kratzer","sequence":"additional","affiliation":[{"name":"Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA 30303, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0661-8261","authenticated-orcid":false,"given":"Charles L.","family":"Wiggins","sequence":"additional","affiliation":[{"name":"University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87131, USA"},{"name":"Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2252-8407","authenticated-orcid":false,"given":"Lihua","family":"Liu","sequence":"additional","affiliation":[{"name":"Los Angeles Cancer Surveillance Program, University of Southern California, Los Angeles, CA 90089, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8802-7686","authenticated-orcid":false,"given":"Bradley D.","family":"McDowell","sequence":"additional","affiliation":[{"name":"Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"ref_1","unstructured":"American Cancer Society (2022). 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