Patterns of Cancer-Related Healthcare Access across Pennsylvania: Analysis of Novel Census Tract-Level Indicators of Persistent Poverty

Background: Persistent poverty census tracts have had ≥20% of the population living below the federal poverty line for 30þ years. We assessed the relationship between persistent poverty and cancer-related healthcare access across census tracts in Pennsylvania. Methods: We gathered publicly available census tract-level data on persistent poverty, rurality, and sociodemographic variables, as well as potential access to healthcare (i.e., prevalence of health insurance, last-year check-up), realized access to healthcare (i.e., prevalence of screening for cervical, breast, and colorectal cancers), and self-reported cancer diagnosis. We used multivariable spatial regression models to assess the relationships between persistent poverty and each healthcare access indicator. Results: Among Pennsylvania’s census tracts, 2,789 (89.8%) were classified as non-persistent poverty, and 316 (10.2%) were classified as persistent poverty (113 did not have valid data on persistent poverty). Persistent poverty tracts had lower prevalence of health insurance [estimate ¼ ―1.70, standard error (SE) ¼ 0.10], screening for cervical cancer (estimate ¼ ―4.00, SE ¼ 0.17) and colorectal cancer (estimate ¼ ―3.13, SE ¼ 0.20), and cancer diagnosis (estimate ¼ ―0.34, SE ¼ 0.05), compared with non-persistent poverty tracts (all P < 0.001). However, persistent poverty tracts had higher prevalence of last-year check-up (estimate ¼ 0.22, SE ¼ 0.08) and screening for breast cancer (estimate ¼ 0.56, SE ¼ 0.15; both P < 0.01). Conclusions: Relationships between persistent poverty and cancer-related healthcare access outcomes differed in direction and magnitude. Health promotion interventions should leverage data at fine-grained geographic units (e.g., census tracts) to motivate focus on communities or outcomes. Impact: Future studies should extend these analyses to other states and outcomes to inform public health research and interventions to reduce geographic disparities.