Despite recommendations for breast and colorectal cancer screenings among the Medicare population, preventive screening rates are often lower among vulnerable populations such as the small but rapidly growing older American Indian and Alaska Native population. According to the 2010 Census, there are approximately 5.2 million American Indian or Alaska Native individuals residing in the United States, which is a growth of almost 10 percent over the last 10 years, and this number is expected to reach 8.6 million by 2050. The population of these individuals age 60 and older is expected to increase from just over 600,000 in 2010 to approximately 1.8 million in 2050.
[Photo: Dr. Marcia G. Ory (left) and Dr. Samuel D. Towne Jr.]
Dr. Samuel D. Towne Jr., assistant professor and postdoctoral fellow, and Dr. Marcia G. Ory, regents and distinguished professor at the Texas A&M Health Science Center School of Public Health, along with Dr. Matthew Lee Smith, of the University of Georgia College of Public Health, recently published a study that identifies potential disparities in the availability of screening services, distance to care, and the utilization of cancer screening services for Medicare beneficiaries residing in areas with a higher concentration of American Indian and Alaska Native populations. According to Dr. Towne, “Native peoples have a wealth of diversity and history. They are also relatively underrepresented in the literature, and face several disparities. More work must be done to try to eliminate such disparities.”
The study used a county-level analysis to collect data across the United States, measuring the overall rates of unmet breast and colorectal cancer screenings in American Indian and Alaska Native older adults, socio-demographic characteristics of areas with a high concentration of these individuals, and identified whether disparities were present with regard to geographic barriers.
The findings concluded that rates of recommended screenings were indeed lower for the American Indian and Alaska Native older population, in comparison to non-Hispanic White adults. For example, the rate of ever having a mammogram was 67 percent for American Indian Alaska Native adults, as compared to 71 percent for non-Hispanic White adults, and the rate of ever having a colonoscopy screening was 55 percent for American Indian Alaska Native adults, as compared to 68 percent for non-Hispanic White adults. The study also discovered that income a key social determinant of health, was lower in areas with a high concentration of American Indian Alaska Native individuals. Additionally, average distance to providers was measured to determine whether geographic barriers were associated with lower screening rates. The study found that in areas with a higher presence of American Indian Alaska Native individuals, the average distance to providers was at least twice that of areas with a lower presence of this population.
The study concluded that one’s geographic location and potential access and availability of cancer screening services and utilization of cancer screening are related. Individuals in areas with higher American Indian or Alaskan Native populations have large gaps in the availability, utilization, and distance to providers when compared to other areas, leading to higher unmet recommended screenings among this population. The study urges federal and state policymakers to work with tribal leaders to close the gap in access and availability for health care, beginning with improvements in screening awareness and the availability of specialists in rural areas. “For public health professionals, these findings help identify targets for interventions, awareness campaigns, and garner more attention and support from policymakers” according to Dr. Ory.
This research was published in the International Journal of Health Geographics, and received a “Highly Accessed” designation, in addition to having been accessed over 2,700 times since publication on June 9.