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Geographic variations in access and utilization of cancer screening services: examining disparities among American Indian and Alaska Native Elders

Samuel D Towne1*, Matthew Lee Smith2 and Marcia G Ory1

Author Affiliations

1 1266 TAMU, Department of Health Promotion and Community Health Sciences, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX 77843-1266, USA

2 Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, 330 River Road, 315 Ramsey Center, Athens, GA 30602, USA

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International Journal of Health Geographics 2014, 13:18  doi:10.1186/1476-072X-13-18

Published: 9 June 2014



Despite recommendations for cancer screening for breast and colorectal cancer among the Medicare population, preventive screenings rates are often lower among vulnerable populations such as the small but rapidly growing older American Indian and Alaska Native (AIAN) population. This study seeks to identify 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 AIAN populations.


Using the county (n =3,225) as the level of analysis, we conducted a cross-sectional analysis of RTI International’s Spatial Impact Factor Data (2012) to determine the level of disparities for AIAN individuals. The outcomes of interest include: the presence of health care facilities in the county, the average distance in miles to the closest provider of mammography and colonoscopy (analyzed separately) and utilization of screening services (percent of adults aged 65 and older screened by county).


Counties with higher concentrations of AIAN individuals had greater disparities in access and utilization of cancer screening services. Even after adjusting for income, education, state of residence, population 65 and older and rurality, areas with higher levels of AIAN individuals were more likely to see disparities with regard to health care services related to mammograms (p ≤ .05; longer distance, lower screening) and colonoscopies (p ≤ .05; longer distance, lower screening).


These findings provide evidence of a gap in service availability, utilization and access facing areas with higher levels of AIAN individuals throughout the US. Without adequate resources in place, these areas will continue to have less access to services and poorer health which will be accelerated as the population of older adults grows.

American Indian; Alaska Native; Cancer; Rural; Disparities; Ecological analysis