Community resilience and its impact on chemotherapy availability: An ecological analysis.

Abdul R Shour Cancer Care & Research Center, Marshfield Clinic Research Institute, Marshfield, WI info_outline Abdul R Shour, Ronald Anguzu, Adedayo A. Onitilo

Authors Abdul R Shour Cancer Care & Research Center, Marshfield Clinic Research Institute, Marshfield, WI info_outline Abdul R Shour, Ronald Anguzu, Adedayo A. Onitilo Organizations Cancer Care & Research Center, Marshfield Clinic Research Institute, Marshfield, WI, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, Wisconsin NCORP, Marshfield, WI Abstract Disclosures Research Funding No funding received None. Background: Cancer patients' resilience influences treatment outcomes, but how community resilience at the ecological level affects hospitals that provide chemotherapy is poorly understood. Methods: Agency for Health Care Research and Quality 2019 ecological data were analyzed (N=3,232 counties). The number of hospitals with chemotherapy services (continuous) was the outcome. The exposure was community resilience- individuals who live with various risk factors (income-poverty ratio, crowding, communication barrier, household unemployment, disability, age 65+; no health insurance, vehicle access, and broadband internet access). Covariates included residential racial segregation-dissimilarity index- degree to which non-white and white residents were distributed across counties, scored 0-100 (integration-segregation) and income inequality scored 0-1 (equality-inequality), recategorized as 10th (low-risk), 11th-89 th (moderate-risk), and 90th (high-risk) percentiles and rural-urban and region. Using STATA/MPv.17, descriptive, chi-square; adjusted negative binomial regression were performed adjusting for population weight. P-values ≤0.05 were considered statistically significant. Results: Chemotherapy services were available in 38.4% of counties. The adjusted model reveals that chemotherapy availability decreased in high-risk than in low-risk resilient areas (Coef.: -1.10, 95% CI: -1.34 - -0.86), but increased in rural than in urban areas (Coef.: 0.36, 95% CI: 0.61- 0.49). Conclusions: Chemotherapy services rose in rural than urban areas and services were less likely to be provided when community resilience was low. Impact of community resilience on chemotherapy availability in US hospitals. Study Variables Bivariate Adjusted Hospital offered chemotherapy No: n=1989 (61.58%) Yes: n=1241 (38.42%) N=3,232 P-value Coef. 95% CI Sig Community resilience: Low Risk 734 (36.9) 133 (10.72) 867 (26.8) <0.001 Ref. Moderate Risk 1227 (61.7) 769 (61.97) 1996 (61.8) -0.70 -0.91 -0.49 *** High Risk 28 (1.4) 339 (27.3) 367 (11.4) -1.10 -1.34 -0.86 *** Residential racial segregation: Low Risk 231 (14.4) 50 (4.1) 281 (10.0) <0.001 Ref. Moderate Risk 1247 (77.7) 992 (82.9) 2239 (79.9) 0.03 -0.25 0.31 High Risk 126 (7.9) 155 (13.0) 281 (10.1) 0.21 -0.09 0.51 Income inequality: Low Risk 269 (13.6) 112 (9.0) 381 (11.8) <0.001 Ref. Moderate Risk 1478 (74.6) 1029 (83.1) 2507 (77.9 0.08 -0.10 0.26 High Risk 234 (11.8) 98 (7.9) 332 (10.3) 0.14 -0.08 0.37 Rural-Urban: Urban 515 (27.0) 651 (52.8) 1166 (37.1) <0.001 Ref. Rural 1395 (73.0) 581 (47.2) 1976 (62.9) 0.49 0.36 0.61 *** Region: Midwest 578 (30.2) 477 (38.7) 1055 (33.6) <0.001 Ref. Northeast 57 (3.0) 160 (13.0) 217 (6.9) -0.17 -0.30 -0.04 *** South 1038 (54.4) 384 (31.2) 1422 (45.2) -0.54 -0.65 -0.43 *** West 237 (12.4) 211 (17.1) 448 (14.3) -0.36 -0.49 -0.23 *** County Population weighted 1 (Exposure) Significance: * p<0.05, ** p<0.01, *** p<0.001.