1. Keila E. Pena-Hernandez NAACCR 2010 Annual Conference Quebec, Canada 06/24/ 2010

2.  A collaborative partnership between the Missouri Department of Health & Senior Services (DHSS) and the University of Missouri - Columbia (MU)  Supported by a Cooperative Agreement between DHSS and the Centers for Disease Control and Prevention (CDC) and a Surveillance Contract between DHSS and MU (#U58/DP00820-03)

3. For their assistance:  Director of Missouri Cancer Registry: Jeannette Jackson-Thompson, PhD, MPH  Research mentor: Mary Jane King, BS  Statistics specialist: Chester Schmaltz  Instant Atlas support staff: Dorothy Graves For their hard work and support of MCR:  Cancer registrars and other reporting facility staff

4. To understand factors that contribute towards cancer health disparities in Missouri

5.  According to the National Cancer Institute, cancer health disparities are defined as differences in the incidence, prevalence, mortality, and burden of cancer and related adverse health conditions that exist among specific population groups in the United States.

6.  “a population where there is a significant disparity [difference] in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in the population as compared to the health status of the general population”- Minority Health and Health Disparities Research and Education Act, 2000

7.  Income and social status  Social support networks  Education and literacy, i.e. health literacy  Employment/Working conditions  Social environments  Physical environments  Life Skills  Personal health practices and coping skills  Healthy child development  Biology and genetic endowment  Health services  Gender  Culture

8.  defined service areas that demonstrate a critical shortage of primary care physicians, dentists, or mental health providers  can be a distinct geographic area, a specific population group within a defined geographic area, or a specific public or non-profit facility

9. http://www.dsf.health.state.pa.us/health/lib/health/primarycare/HPSADesBook.pdf

11.  Previous research has revealed that medically underserved populations are at higher risk of being diagnosed with late-stage cancer.  Rural populations also face financial, physical and cultural barriers that prevent them from obtaining effective health care.

12. We examined contributing factors:  Health profession shortage areas (HPSAs): Low Income ▪ Low income individuals with incomes at or below 200% of the federal poverty level. A minimum of 30% of the population within the rational service area must be low income in order to pursue this type of designation.

13.  Medically Underserved Areas/Populations (MUAs/MUPs)  areas or populations designated by HRSA as having: too few primary care providers, high infant mortality, high poverty and/or high elderly population.  Poverty Rate  percentage of people (or families) who are below poverty

14.  Missouri Cancer Registry (MCR)  Cancer incidence data, 1996-2007  Community Information Management (CIM)  Poverty, MUA, HPSA, State, County Boundaries

15. Preliminary analysis

16. Madison Ripley Significantly high cancer rates Significantly low cancer rates

17. Madison Ripley Benton Saline St. Louis City & St. Louis County Significantly high cancer rates Significantly low cancer rates Medically Underserved Area

18. Ripley Butler Significantly high cancer rates Significantly low cancer rates

19. GIS Approach

20.  Geographic Data Visualization Software  improves the visual communication of location- based statistical data.

21.  The ability of InstantAtlas to allow for quick and easy data reports while displaying statistical information on highly interactive maps allows the end-user to discover patterns, trends, relationships and anomalies.

27.  Using GIS tools is a good starting point for investigating health disparities  Allows for the assessment of future needs in GIS studies relating to inequalities of HPSA groups  Provides evidence of the pivotal role of small area analysis for GIS and policy makers

28.  Any Questions?  Contact Information: E-mail: kep989@mail.missouri.edu