Institutional review board approval was not needed for this study, as all data used were publically available. The inclusion criterion for this study was cancer deaths as reported to the National Cancer Institute (NCI). “All cancer” was defined as all invasive cancer sites, including bladder, breast, brain, cervix, childhood cancers (all sites combined), colon and rectum, esophagus, kidney, leukemia, liver and bile duct, lung and bronchus, skin melanomas, non-Hodgkin lymphoma, oral cavity and pharynx, ovary, pancreas, prostate, stomach, thyroid, and uterus. “Lung cancer” was defined as cancers of the lung and bronchus.
Five criteria were used in determining whether an area qualifies for the designation of VMUA: (1) percentage of population whose income is at or below 100% of the federal poverty level, (2) percentage of population aged 65 years or older, (3) primary care physician-to-patient ratio, (4) infant mortality rates, and (5) unemployment rate.
11 The practice of designating health care professional shortage areas in VMUAs has been a national strategy to identify areas with the greatest health disparities. Areas were selected according to specific geographic, population, and facility criteria. The use of designations such as VMUA has not only been useful for decisions on allocation of efforts and funds, but it also assists osteopathic physicians, who are educated on and attentive to the philosophies of care specific to rural areas and MUAs.
Publically available data from the NCI state cancer profile and the Virginia Department of Health for the years 2005 to 2009 were obtained and evaluated.
5 These dates were selected because they had the latest available data at the time of the analysis. Mortality data were obtained from the National Vital Statistics System public use data file, and mortality rates were calculated by the NCI’s SEER*Stat. The NCI data were derived from the state cancer registries, which collect data on cancer-related deaths. For all NCI data, the average annual percent change (AAPC) was based on the percent change calculated by the Joinpoint Regression Program. The data for VMUA and non-VMUA were obtained from the Virginia Department of Health.
5 Mortality rates were age-adjusted to the 2000 US standard population. All-cancer and lung cancer mortality rates were obtained from VMUA and non-VMUA counties and cities in Virginia
2 and reported by trends of increasing, decreasing, and stable rates. Increasing mortality rate was defined by the NCI as a 95% CI of AAPC above 0; decreasing mortality rate was defined as a 95% CI of AAPC below 0; and stable mortality rate was defined as 95% CI of AAPC of 0.
A χ2 statistical analysis was used for the categorical data, with 1 dichotomous variable and 3 levels of nominal outcomes. The significance level for all data was set at P≤.05.