Journal article
Multilevel analysis in rural cancer control: A conceptual framework and methodological implications
Preventive medicine, Vol.129, pp.105835-105835
12/2019
DOI: 10.1016/j.ypmed.2019.105835
PMCID: PMC7136953
PMID: 31520673
Abstract
Rural populations experience a myriad of cancer disparities ranging from lower screening rates to higher cancer mortality rates. These disparities are due in part to individual-level characteristics like age and insurance status, but the physical and social context of rural residence also plays a role. Our objective was two-fold: 1) to develop a multilevel conceptual framework describing how rural residence and relevant micro, macro, and supra-macro factors can be considered in evaluating disparities across the cancer control continuum and 2) to outline the unique considerations of multilevel statistical modeling in rural cancer research. We drew upon several formative frameworks that address the cancer control continuum, population-level disparities, access to health care services, and social inequities. Micro-level factors comprised individual-level characteristics that either predispose or enable individuals to utilize health care services or that may affect their cancer risk. Macro-level factors included social context (e.g. domains of social inequity) and physical context (e.g. access to care). Rural-urban status was considered a macro-level construct spanning both social and physical context, as “rural” is often characterized by sociodemographic characteristics and distance to health care services. Supra-macro-level factors included policies and systems (e.g. public health policies) that may affect cancer disparities. Our conceptual framework can guide researchers in conceptualizing multilevel statistical models to evaluate the independent contributions of rural-urban status on cancer while accounting for important micro, macro, and supra-macro factors. Statistically, potential collinearity of multilevel model predictive variables, model structure, and spatial dependence should also be considered.
•Rural populations experience disparities across the cancer control continuum.•Rural residence may be most appropriately considered as a contextual variable.•A multilevel conceptual framework can guide analysis of rural cancer outcomes.•Methodological implications (e.g. collinearity) should be considered in analysis.
Details
- Title: Subtitle
- Multilevel analysis in rural cancer control: A conceptual framework and methodological implications
- Creators
- Whitney E Zahnd - Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Suite 204, Columbia, SC 29210, United States of AmericaSara L McLafferty - Department of Geography and Geographic Information Science, University of Illinois Urbana-Champaign, 1301 W. Green Street Urbana, IL 61801, United States of AmericaJan M Eberth - Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Suite 204, Columbia, SC 29210, United States of America
- Resource Type
- Journal article
- Publication Details
- Preventive medicine, Vol.129, pp.105835-105835
- DOI
- 10.1016/j.ypmed.2019.105835
- PMID
- 31520673
- PMCID
- PMC7136953
- NLM abbreviation
- Prev Med
- ISSN
- 0091-7435
- eISSN
- 1096-0260
- Publisher
- Elsevier Inc
- Grant note
- DOI: 10.13039/100010001, name: Federal Office of Rural Health Policy; DOI: 10.13039/100000030, name: Centers for Disease Control and Prevention
- Language
- English
- Date published
- 12/2019
- Academic Unit
- Health Management and Policy
- Record Identifier
- 9984214784902771
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