UF Health Cancer Center | Catchment Area Profile 2021

2021

UF HEALTH CANCER CENTER

CATCHMENT AREA PROFILE PREPARED BY THE UFHCC OFFICE OF COMMUNITY OUTREACH AND ENGAGEMENT

Welcome from the

UF HEALTH CANCER CENTER LEADERSHIP

“ While the past year has been fraught with uncertainty, our Cancer Center has remained steadfast in its commitment to prevent, detect and ultimately cure cancer and address the unique challenges of the cancer burden faced by the population we serve by facilitating innovative cancer research.”

The University of Florida Health Cancer Center (UFHCC) continues to provide exceptional care, engage in groundbreaking research and foster transdisciplinary collaborations to ensure that those residing within our 23-county catchment area have access to world class cancer care. While the past year has been fraught with uncertainty, our Cancer Center has remained steadfast in its commitment to prevent, detect and ultimately cure cancer and address the unique challenges of the cancer burden faced by the population we serve by facilitating innovative cancer research.

We will achieve these goals through discovery and research innovations in cancer mechanisms, prevention, screening and treatment, while training the next generations of cancer scientists and experts, all while reaching out to the communities and populations we serve.

This catchment area profile provides a glimpse of the factors related to cancer health outcomes, both in terms of burdens or barriers, but it also identifies some of the assets and successes within. Our catchment area is distinguished by

its large rural population and high rates of socioeconomic vulnerability, particularly among minority groups, as well as an aging population. The region is also characterized by high rates of smoking, obesity and late-stage cancer diagnosis compared with the rest of Florida and the U.S. Through our Office of Community Outreach and Engagement, UFHCC has initiated programs to increase health literacy, cancer screening and clinical research engagement. Innovations from UFHCC science translated to the clinic include synthetic lethal approaches to attack tumors, novel immunotherapies, new strategies to communicate with cancer patients and mobile app-based smoking-cessation programs.

As we look towards the future, know that there is tremendous promise for progress in cancer research and care with our catchment area leading the way as a model for change.

JONATHAN D. LICHT, M.D.

Director, UF Health Cancer Center

“ This profile depicts the unique cancer burden challenges that our 23 counties face. The charge of the Office of Community Outreach and Engagement is to address those challenges by developing creative community-engaged strategies that serve our diverse population — from prevention to survivorship.”

The Office of Community Outreach and Engagement is pleased to present the UF Health Cancer Center Catchment Area Profile. This summary is designed to explicate our catchment area characteristics, priorities and determinants of cancer incidence, mortality and advanced stage diagnoses to support the UFHCC in reducing the cancer burden across the cancer care continuum.

This profile depicts the unique cancer burden challenges that our 23 counties face. The charge of the Office of Community Outreach and Engagement is to address those

challenges by developing creative community-engaged strategies that serve our diverse population — from prevention to survivorship.

We hope this Catchment Area Profile and PORTRAIT is insightful and exhibits our efforts to assist you in the development or enhancement of your cancer-related endeavors.

BETSY SHENKMAN, PhD

Associate Director, UFHCC Office of Community Outreach and Engagement

1. UFHCC CATCHMENT AREA PROFILE INTRODUCTION ........2 Profile Purpose & Uses..................................................................................3 The COE Team ...............................................................................................5 Community Advisory Board ......................................................................... 7 COE Guiding Principles: Community-Engaged Research .........................9 Integrating COE with UFHCC Clinical Research......................................... 11 Collaborative Partnership Profiles .............................................................. 13 Acknowledgments ....................................................................................... 17 Abbreviations ...............................................................................................18 2. UFHCC CATCHMENT AREA AND POPULATION .................20 The UFHCC Catchment Area ....................................................................... 21 Catchment Area Population in Perspective ...............................................22 Key Definitions..............................................................................................23 An Integrative & Intersectional Framework...............................................28 Basic Demographics of the Catchment Area ............................................30 Minority Group Populations ........................................................................34 Local Case Study: Access to Care among Latina Immigrants..................35 3. CANCER IN THE UFHCC CATCHMENT AREA .................... 40 Incidence, Advanced Stage Cancer Incidence and Mortality Rates........41 Top Cancers in the UFHCC Catchment Area .............................................48 Effective Screening Recommendations .....................................................50 Site-specific Analysis of Cancer Incidence ................................................51 Site-specific Analysis of Advanced Stage Incidence ................................56 Site-specific Analysis of Mortality ..............................................................60 4. CO-OCCURRING CONDITIONS ........................................ 64 Co-occurring Conditions and Cancer Diagnosis .......................................65 5. CANCER RISK FACTORS .................................................68 Risk Factors in the UFHCC Catchment Area ..............................................69 6. CATCHMENT AREA PRIORITY CANCERS .......................... 76 UFHCC Priority Cancers: Criteria Identification & Selection .................... 77 7. REFERENCES AND DATA SOURCES .................................86 References ....................................................................................................87 Data Sources .................................................................................................88 Cover images and those show here were provided by Acorn Clinic, Gainesville Community Redevelopment Association, Gainesville Sun, and Kali Bowen

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UF Health Cancer Center Catchment Area Profile

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UF HCC C ATC H M ENT A R E A P ROF I L E I NTROD UCTION

UF Health Cancer Center Catchment Area Profile

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Profile Purpose & Uses

PROFILE DESCRIPTION This report describes the catchment area cancer incidence, advanced stage diagnoses and mortality along with the factors that impact cancer health outcomes, both in terms of burdens or barriers, as well as assets and successes. We highlight data about the catchment area, local expertise that support cancer control within our 23-county catchment area in north central Florida, and cancer control research at the UF Health Cancer Center.

INTENDED AUDIENCE Our initial audience is the Cancer Center researchers who do basic, clinical, and cancer control and population science research. The aim is to give them access to current data so that they can design studies that are as relevant as possible to our catchment area.

We are making the data accessible and useful for various audiences by developing and deploying an online interactive tool called PORTRAIT, or Partnerships to Optimize and Transform Research through Action and Impact Together, that will allow researchers and clinicians to access even more information about the UFHCC catchment area and its cancer burden.

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UF Health Cancer Center Catchment Area Profile

COMMUNITY OUTREACH & ENGAGEMENT AIMS The UFHCC and its Office of Community Outreach and Engagement (COE) are committed to reducing cancer-related health disparities and burden across the catchment area and beyond across the cancer care continuum. The COE office is focused on the following aims in this report:

1.

2.

DEFINING

the catchment area and deeply

understanding its cancer burden (Aim 1); ENGAGI NG AN D ALIGN I NG

basic, clinical and cancer

control and population scientists with the varied and diverse communities we aim to serve to better focus the UFHCC research agenda on catchment area burden (Aim 2);

3.

E X PA N D I N G

the impact of the UFHCC research

by strengthening the cancer focus of existing engagement efforts such as HealthStreet and the UF Institute of Food and Agricultural Sciences (UF/IFAS) County Extension Program to build trust, provide education, increase knowledge about cancer clinical trials at UFHCC, and facilitate clinical trial enrollment (Aim 2);

4.

D I S S E M I N AT I N G A N D I M P L E M E N T I N G

evidence-based

strategies across the cancer care continuum, building on COE’s relationships with the Florida Department of Health, the regional Cancer Control Collaboratives across the state, the Agency for Health Care Administration, Community Health IT, Sisters Alive and the OneFlorida Clinical Research Consortium, among others (Aim 3); and,

5.

TA R G E T I N G

COE’s policy-related efforts toward two of

the catchment area’s major issues – tobacco use and limited access to care (Aim 4).

QUESTIONS?

HOW TO CITE THIS REPORT

Please contact the Office of Community Outreach and Engagement at COE@cancer.ufl.edu.

Szurek SM, Hall J, Cho HD, Guo Y, Shenkman EA. (2021) The UF Health Cancer Center Catchment Area Profile Report 2021.

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The Community Outreach and Engagement Team

B E T SY S H E N K M A N , P h D, A S S O C I AT E D I R E C T O R O F C O E

SA R A H M . S Z U R E K , P h D, PROGRAM DIRECTOR OF COE

JODIAN BLAKE, MPH, CTTS, C O M M U N I T Y H E A LT H R E S O U R C E C O O R D I N AT O R

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UF Health Cancer Center Catchment Area Profile UF Health Cancer Center Catchment Area Profile

L AT R I N A M A S S E Y, M P H , C O M M U N I T Y H E A LT H R E S O U R C E C O O R D I N AT O R

E L I Z A B E T H S H E N K M A N , P h D , is the Chair of the Department of Health Outcomes and Biomedical Informatics and the Associate Director for Community Outreach and Engagement for the UF Health Cancer Center.

As a health outcomes researcher, she focuses on: 1) determining which combinations of health care delivery, community, and patient factors influence quality and outcomes of care; and 2) developing and testing corresponding evidence-based strategies to reduce disparities in health outcomes among underserved populations. She is also the PI for the OneFlorida Clinical Data Research Network which is comprised of nine different health system partners caring for over 11 million Floridians. The Floridians in this network include vulnerable populations who are rarely or minimally included in traditional clinical trials (e.g., those of lower socioeconomic status, racial and ethnic minorities, children, and older adults). She is an elected member of the Society for Pediatric Research and the American Pediatric Society.

S A R A H M . S Z U R E K , P h D , is the Program Director for the Office of Community Outreach and Engagement and is responsible for developing and managing community-based programs that identify cancer-relevant needs, target cancer prevention, and improve health outcomes in twenty-three counties in Florida. She is a medical anthropologist whose work focuses on understanding the social and cultural factors that influence health outcomes among vulnerable populations in order to develop targeted, evidence-based programs to positively affect health in community settings. Sarah has worked with Mexican immigrants in Alabama to examine how personal social networks affect diabetes risk, and with African Americans in Florida on community-based participatory research projects related to racism, cardiovascular disease, and the local food environment. She previously directed the Florida Healthy Kids Program evaluation, which examined the quality of care that children receive in the state.

J O D I A N B L A K E , M P H , C T T S , is a Community Health Resource Coordinator for the Office of Community Outreach and Engagement at the UF Health Cancer Center. In COE she is responsible for developing and maintaining relationships with key stakeholders in the UFHCC catchment area to identify the cancer-relevant needs of the community. She partners with UFHCC researchers and cancer focused organizations on identifying appropriate research studies, resources and programs for community members, those diagnosed with cancer, their family members, and other cancer caregivers. In addition to these activities, she is also the leader of key community education initiatives within the COE office, most notably the monthly Cancer Connections lecture series. Jodian has been a Certified Tobacco Treatment Specialist for over seven years facilitating group tobacco cessation counseling sessions using motivational interviewing techniques and evidence-based tobacco cessation interventions. Most recently she served as the Tobacco and Health Program Manager at Suwannee River Area Health Education Center (AHEC) overseeing the Tobacco Free Florida AHEC Cessation Programs for 12 North Central Florida counties. While at AHEC Jodian was involved in establishing and maintaining strategic partnerships with healthcare facilities, behavioral health facilities, and other local organizations offer onsite tobacco cessation programs, and training current and future healthcare providers on evidence-based tobacco cessation interventions.

L AT R I N A M A S S E Y, M P H , is the newest Community Health Resource Coordinator for the Office of Community Outreach and Engagement at the University of Florida Health Cancer Center and is located in Tallahassee at the Bond Community Health Center (a Federally Qualified Health Center). She got her BA and MPH at FAMU (an HBCU), and was a Community Health Worker in Tallahassee, which means she has a broad preexisting network in the health sector (clinics, Tallahassee Memorial Hospital) as well as among many grassroots organizations. Massey has experience with clinical trials after her work with the United States Army at Ft. Benning, GA. She has worked alongside research professionals, military leadership, stakeholders, policy makers, and community members. As a community health worker, she spent much of her time providing health education, care coordination and navigation, and addressing social determinants of health to close health gaps. Given this experience, LaTrina is responsible for many key activities related to integrating COE metrics into the interventional cancer clinical trials that are reviewed by the Scientific Monitoring Review Board (SRMC), and the Disease Site Groups (DSGs) at the UFHCC.

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Community Advisory Board

T H E U F H C C C O M M U N I T Y A DV I S O RY B OA R D ( C A B )

plays a vital role in collaborating with our leadership

team, program directors and cancer center members, meeting quarterly to ensure that our work focuses on cancer-related issues that are critical to the communities we serve.

THE PRIMARY ACTIVITIES OF THE CAB ARE TO:

• •

Review cancer-focused catchment area data and make recommendations for research topics of importance to the community; Collaborate with researchers and provide recommendations on research design, participant recruitment and retention, interpretation of findings and dissemination of results for UFHCC-affiliated research projects;

SHIRLEY BLOODWORTH, MSN

Citizen Scientist and Community Advocate

AMY BUCCIARELLI, M S , AT R - B C

Assistant Director and Lecturer, UF Center for Arts and Medicine

A N N WA L S H C O L L E T T

•

Serve as a liaison between the local community and UFHCC researchers; and Collaborate with and advise the UFHCC Community Outreach and Engagement leadership about programmatic initiatives to reduce cancer risks and burden in the catchment area.

LI N DA B. COT TLER , P h D, M P H

COE CAB Faculty Advisor Director of Community Engagement, Clinical and Translational Science Award Associate Dean for Research, College of Public Health and Health Professions Dean’s Professor of Epidemiology

JEFF FELLER, MSISE

Chief Executive Officer, WellFlorida Council

JERI FRANCOEUR, MS

Childhood Cancer Advocate President, Headlight Data

Advocacy Committee Chair, Florida Breast Cancer Foundation

SUE COLSON

ROBERT H. HOULIHAN, D H A , M B A , FA C H E , CCRP, CR A, C AO

COE CAB Chair Cedar Key City Commissioner

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UF Health Cancer Center Catchment Area Profile

UFHCC Associate Director for Administration COE CAB ex officio member

HARRIETTE HUDSON

RICK MEDINA, MBA

Chair, Sisters Alive Tallahassee

Member, Climb for Cancer Foundation

FRANCES KNIGHT

BARBARA RICHARDSON, P h D, R N

Member, Sisters Alive Tallahassee

R O B I N L E W Y, M A

Director, UF Area Health Education Center (AHEC) Program

E . S TA N L E Y R I C H A R D S O N

Director of Programming, Rural Women’s Health Project

Citizen Scientist, Founder and Director, ARTSPEAKSgnv, Alachua County Inaugural Poet Laureate

J E N N I F E R M c K AT H A N

KENDRA S I L E R - M A R S I G L I O, P h D

Cancer Control Strategic Partnerships Manager, American Cancer Society

President and CEO, CommunityHealth IT

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COE Guiding Principles: Community-Engaged Research

C O M M U N I T Y- E N G A G E D R E S E A R C H ( C E n R )

is a framework for research that aims to improve health

outcomes by involving the community—however they define themselves (by geography, common interests or other affiliation) (1, 2). The principles of CEnR aim to form equitable partnerships and shared leadership among the community and researchers, with emphasis on transparent bi-directional communication, mutual benefit, and sustained commitment to change (ibid).

Figure 1: Core Principles for Conducting Community-Engaged Research

1.

2.

3.

4.

5.

6.

T R A N S P A R E N C Y, H O N E S T Y, T R U S T

W H O P A R T I C I P AT E S I N C O M M U N I T Y- E N G A G E D RESEARCH?

SHARED DECISION MAKING

1. Community Members and Families 2. Community- and Faithbased Organizations 3. Researchers 4. Clinicians 5. Educators 6. Health System Leaders 7. Businesses and Media 8. Policy Makers

MUTUAL CO-LE ARN I NG

B I - D I R E C T I O N A L C O M M U N I C AT I O N

S U S TA I N A B I L I T Y

E Q U I TA B L E C O M P E N S AT I O N

Adapted from Rhodes et al. 2018 and McCloskey et al. 2011

THE PROCESS OF COMMUNITY-ENGAGED RESEARCH Community-Engaged Research can be thought of as a continuum of community involvement, from minimal involvement where the research is largely investigator-driven, or where there is a one-way transfer of information or resources, to situations where consulting relationships are in place, culminating in community-driven research at the other end of the continuum (1).

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UF Health Cancer Center Catchment Area Profile

This continuum provides a range of options for basic, clinical and cancer control and population science research at UFHCC: Researchers can work with community members along any point of this continuum, while still embracing the principles of transparent and open communication when engaging with others.

Figure 2: The Continuum of Community-Engaged Research

C O M M U N I T Y I N V O LV E M E N T I N R E S E A R C H

P O W E R & C O N T R O L • R E S P O N S I B I L I T Y & O W N E R S H I P • P A R T I C I P AT I O N • I N F L U E N C E

Investigator-Driven Research

Community Placed/Based Research

Community-Engaged Research

Community-Based Participatory Research

L O W I N V O LV E M E N T

Community-Driven Research

H I G H I N V O LV E M E N T

Source: Building Equitable Partnerships for Environmental Justice Curriculum. (2018). Retrieved January 29, 2021, from mleead.umich.edu/files/Building%20Equitable%20Partnerships%20for%20Environmental%20Justice%20Curriculum.pdf

The “Stepwise Guide for Conducting Community-Engaged Research” by Rhodes et al.

(2018) outlines clear steps for initiating collaborations with community members.

Many of these steps, like networking, building trust and dissemination are continual processes, not one-time events.

In addition, prioritizing, model building and co-interpretation should be thought of as iterative conversations with community members, partners and stakeholders.

If you want to learn more about CEnR, contact the Community Outreach and Engagement office.

Figure 3: A Stepwise Guide to Community-Engaged Research NETWORK E S TA B L I S H P A R T N E R S H I P S B U I L D & M A I N TA I N T R U S T I D E N T I F Y H E A LT H P R I O R I T I E S C O N D U C T B AC KG R O U N D R E S E A R C H PRIORITIZE BUI LD CON SEN SUS ON G OALS & RESE ARCH QUESTION S BUI LD A CONCEPTUAL MODEL D E S I G N ST U DY C R E AT E A N A LY S I S & D I S S E M I N AT I O N I M P L E M E N TAT I O N D ATA C O L L E C T I O N D ATA A N A LY S I S C O - I N T E R P R E TAT I O N O F F I N D I N G S D I S S E M I N AT I O N & T R A N S L AT I O N Adapted from Rhodes et al. 2018

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Integrating COE with UFHCC Clinical Research

TRACKING THE RELEVANCE OF CANCER CLINICAL TRIALS TO THE CATCHMENT AREA Figure 4: An Assessment of Cancer Clinical Trial Recruitment Feasibility Using the Trial Performance Dashboard.

Figure 5: The Overlapping Populations & Different Data Sources Used in the Trial Performance Dashboard

Overall Florida Population OneFlorida Population UFHealth EHRs

FCDS Population

= OnCore

The UF Health Cancer Center is uniquely positioned to blend comprehensive patient care and innovative research in a collaborative, multi-disciplinary environment. The research at UF aims to address the complex needs of the catchment area to reduce the cancer burden and increase health equity. Therefore, the Office of Community Outreach and Engagement has partnered closely with Disease Site Group (DSG) leadership in the development of the catchment area rubric.

The catchment area rubric was designed to assist DSGs to better articulate how their research relates to the catchment area.

This rubric is completed by the COE team for all interventional studies under initial review and is presented at the twice-monthly Scientific Review and Monitoring Committee (SRMC) meetings. The COE office also tracks demographic characteristics of all participants on actively-enrolling clinical trials and works with investigators to identify strategies to facilitate enrollment and raise awareness within the community about cancer clinical trials opportunities. This work is done in collaboration with other community engagement resources including UF HealthStreet and the STEM Translational Communication Center (TCC) within the UF Clinical and Translational Science Institute (CTSI).

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UF Health Cancer Center Catchment Area Profile

The rubric contains four domains to assess the extent to which the proposed clinical research addresses: 1. A top ten cancer; 2. Top cancer risks (e.g., related to tobacco use); 3. Advanced stage disease and/or; 4. Disparities based on rural residence, race, ethnicity and/or sex.

FACILITATING CANCER CLINICAL TRIALS ENROLLMENT In addition to reviewing all interventional cancer clinical trials using the catchment area rubric, the UFHCC and COE office, in collaboration with the Cancer Informatics Shared Resource (CI SR), has developed a Trial Performance Dashboard to (1) assess cancer trial feasibility with a focus on identifying potential participants based on trial inclusion and exclusion criteria (Figure 6 below), and (2) examine recruitment and enrollment progress relative to those potentially eligible for the trials (Figure 4), with a particular focus on enrollment of individuals who are traditionally underrepresented in cancer clinical trials. The dashboard leverages a diverse set of patient data sources (Figure 5) including trial data from the UF Clinical Trials Management System OnCore®, patient data from the UF Health system (i.e., UF Integrated Data Repository linked with UF Tumor Registry), in addition to patient data from

the Florida Cancer Data System (FCDS) and the OneFlorida Clinical Research Consortium (i.e., a unique data resource covering ~15 million, > 60% Floridians), that covers the broader Florida regions in our catchment area.

The COE office uses this information to meet with investigators to discuss opportunities to enhance their ability to enroll individuals who are potentially eligible from diverse backgrounds by (1) identifying opportunities to create patient registries, (2) partnering with HealthStreet to reach out to community members and screen them for trial eligibility, (3) partnering with County Extension and other initiatives and community groups to provide education about the particular cancers addressed through the trials to raise awareness, among other strategies.

Figure 6: Cancer Clinical Trial Recruitment Progress Assessment Using the Trial Performance Dashboard

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Collaborative Partnership Profiles

TH E OFFICE OF COM MUN IT Y OUTRE ACH AN D ENGAGEM ENT

is using community-engaged research

principles that include forming equitable partnerships to build trust and collaborate with community members, organizations, clinicians, families, health-system leaders and policy makers in planning and decision-making about catchment area cancer-related needs and outreach (4).

We provide details about essential programs from our partners and colleagues in this section.

These key programs for the COE office were selected based on their roles in building trust with communities, particularly in rural areas (UF/IFAS County Extension, HealthStreet), facilitating research that addresses catchment area burden and enrollment of underrepresented groups in cancer clinical trials (HealthStreet, OneFlorida, CaRE2 Health Equity Center), and engaging communities through education and outreach (UF/IFAS County Extension, HealthStreet, OneFlorida, CaRE2 Health Equity Center). At the UFHCC, the leadership, researchers, scientific teams and staff have a long-term commitment to strengthening these essential partnerships, as well as forging new bonds with additional organizations.

UF IFAS & COUNTY EXTENSION OFFICES The University of Florida’s Institute of Food and Agricultural Sciences (IFAS) Extension Office is a partnership between federal, state and county governments to bring knowledge and resources to the public. This partnership includes faculty members, scientists, educators, administrative staff and volunteers whose aim is to provide services and improve the lives of Floridians in all 67 counties. Services include agricultural management education, 4-H Youth Development programs, Master Gardener, Master Naturalists and Master Beekeepers Programs, Florida-Friendly landscaping program, healthy living resources, money management skills, nutrition and cooking information, homeownership resources and relationship advice. Much of this information can be learned through in-person classes at UF/IFAS Extension offices, but there is also a wealth of knowledge available on their website and additional opportunities are offered online, such as professional licensing for food-service

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UF Health Cancer Center Catchment Area Profile

workers and childcare workers. To support stakeholder-engaged activities and foster an inclusive research environment, the UFHCC Office of Community Outreach and Engagement also works in partnership with the County Extension Program, which offers cancer-related programming in each of Florida’s 67 counties.

An IFAS Extension Agent and a watermelon farmer examine a soil moisture monitoring device.

UF HEALTHSTREET

Community Health Workers from HealthStreet Photo credit: Suzanna Mars for Gainesville Magazine

UF HealthStreet is a community engagement program with a mission to reduce disparities in health care and research. As trusted community members, HealthStreet’s Community Health Workers (CHWs) help achieve this goal by going out into the community and building meaningful connections with people in their neighborhoods.

CHWs work throughout Gainesville and surrounding rural communities talking to people where they gather, such as at parks, community and senior centers, transportation hubs, and beauty/barber shops. When a community member agrees to join the HealthStreet cohort, a CHW assesses their health conditions, health concerns, social determinants of health and research perceptions. Based on their needs, CHWs provide community members with health education, referrals for medical and social services and opportunities to participate in relevant health research studies.

The CHWs gather self-reported information about individuals’ history of and current cancer diagnoses. From November 2011 through December 2020, HealthStreet followed 1,097 individuals with a self-reported cancer diagnosis.

Top cancers in this cohort are reflective of the top 10 cancers in the UFHCC catchment area,

including breast, colon and prostate.

The HealthStreet cohort also participates in the UF Consent2Share Program; people who complete the Health Intake agree to have investigators directly contact them for potential study participation. From 2016-2020, 472 individuals with a cancer diagnosis in the HealthStreet database were navigated to cancer-relevant studies with 128 ultimately electing to participate in research. More than half (55%) were from under-represented groups. Overall, the UF HealthStreet CHWs help a broader cross-section of the population increase their participation in research, furthering our understanding of the diverse communities in Florida.

HealthStreet hosts Our Community Our Health, which uses a town hall format with speakers at a central location. Cancer-related topics are offered on a periodic basis. HealthStreet also hosts a UFHCC-sponsored community group called Cancer Connections, which is a monthly educational and networking meeting for cancer healthcare professionals, cancer patients, survivors, and caregivers. Continuing education credits are offered for health professionals through another important partner, Suwannee River Area Health Education Center (AHEC).

HealthStreet is active at community events.

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ONEFLORIDA’S LINKED & LAYERED STATEWIDE DATA: FACILITATING RESEARCH & ACTION Figure 7: OneFlorida Partners, Practices, and Collaborations

HEALTH CARE SYSTEMS & AFFILIATED PRACTICES

•• •• •• •• •• •• •

University of Florida and UF Health - OneFlorida CC Emory University Florida State University University of Alabama at Birmingham University of Miami and UHealth University of South Florida and USF Health AdventHealth Nicklaus Children’s Hospital Orlando Health System Tallahassee Memorial HealthCare Tampa General Hospital Bond Community Health Center Inc. CommunityHealth IT

STATE AGENCY & ORGANIZATION COLLABORATIONS

Capital Health Plan Florida Agency for Health Care Administration Florida Department of Health

The OneFlorida Clinical Research Consortium, funded by the Patient-Centered Outcomes Research Institute (PCORI), is a partnership throughout the state that comprises a network of 12 health systems, 1,240 physician practice/ clinic settings, more than 4,100 physicians, and 22 hospitals providing care for 15 million Floridians.

The Floridians in this network include vulnerable populations who are rarely or minimally included in traditional clinical trials (e.g., those of lower socioeconomic status, racial and ethnic minorities, children and older adults). OneFlorida has a shared governance model that engages patients and community clinicians in the identification of important research topics and the design, conduct, analysis and dissemination of research findings.

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UF Health Cancer Center Catchment Area Profile

The OneFlorida Data Trust maintains a repository of linked electronic health records (EHR), health care claims, tumor registry, census-tract and vital statistics data on 15 million Floridians from 2012 to the present. EHR data are refreshed monthly; tumor data every six months and claims data every month to annually, depending on the source. A key mission of OneFlorida is to reduce disparities and improve cancer outcomes in the catchment area and Florida by assembling, linking and harmonizing data to facilitate research spanning the cancer continuum. The data are used to more precisely target and tailor outreach and interventions to those at risk for poor outcomes.

OneFlorida collaborates with 10 health systems throughout Florida: the University of Miami Sylvester Cancer Center, the Florida Department of Health and the Florida Agency for Health Care Administration.

CANCER RESEARCH EDUCATION AND ENGAGEMENT (CaRE²) HEALTH EQUITY CENTER Two cancer researchers at UF, Folakemi T. Odedina, PhD., and Diana Wilkie, PhD. established the Florida-California Cancer Research and Engagement (CaRE²) Health Equity Center, a bicoastal partnership with two other organizations—the University of Southern California (USC) Norris Comprehensive Cancer Center and the Florida Agricultural and Mechanical University (FAMU) in Tallahassee (Figure 8). All partners are dedicated to reducing cancer health disparities, increasing education and intensifying outreach, with a focus on underserved Black and Latinx populations. Funded in 2018 through the

National Institutes of Health/National Cancer Institute (NCI) Comprehensive Partnerships to Advance Cancer Health Equity U54 grant mechanism, the new program is part of the NCI Partnerships to Advance Cancer Health Equity (PACHE) initiative.

Community engagement and education of underrepresented students are at the heart of this innovative program. The overall goal is to build institutional partnerships that are sustainable, long term and beneficial for all involved to positively impact the national cancer program.

Figure 8: The Cancer Research Education and Engagement Health Equity Center Model

FA M U

• • • • •

Minority Student Focus Community Trust Black & Latino Populations Health Disparities Focus MiCaRT Center

UFHCC

• • • • •

USC- NCC

• • • • •

Cancer Research Expertise CTSI Outreach to Black & Latinos in FL State of the Art Science MiCaRT Center

NCI-designated Center Cancer Research Expertise CTSI Outreach to Black & Latinos in CA State of the Art Science

I N N O VAT I V E T R A N S L AT I O N A L R E S E A R C H A M O N G B L A C K S & L AT I N O S O N C A N C E R W I T H H I G H M O R TA L I T Y

INCREASED COMMUNITY ENGAGEM ENT

INCREASED URM RESEARCHERS IN THE US

INCREASED R E S E A R C H C A PAC I T Y AT FA M U

INCREASED CANCER D I S PA R I T I E S RESEARCH

Adapted from UF Health CaRE2 Health Equity Center

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Acknowledgments

O U R W O R K I S F O S T E R E D T H R O U G H S E V E R A L W E L L - E S TA B L I S H E D I N I T I AT I V E S

including HealthStreet

(a UF Clinical and Translational Science Institute (CTSI) and UFHCC-supported community health engagement resource), the UF/IFAS County Extension Program, OneFlorida, the U54 CA233444-funded CaRE2 Health Equity Center and the UFHCC Cancer Informatics Shared Resource.

The COE office also has long-standing collaborations with local and state partners, including the Florida Department of Health, the WellFlorida Council, Inc., the North Central Florida Cancer Control Collaborative, the Rural Women’s Health Project, Agency for Health Care Administration, the Florida Medicaid Program, CommunityHealth IT, the Area Health Education Centers, and Sisters Alive, a local support group for Black women.

We specifically wish to thank the following people for their dedication and work:

• • • • • •

17

UFHCC Leadership and Program Leaders UFHCC Community Advisory Board Citizen Scientists Kristie Hill and E. Stanley Richardson UFHCC Cancer Informatics Shared Resource The Rural Women’s Health Project—special thanks to Kaeli Flannery and Robin Lewy UF Faculty: Sarah Szurek, Ph.D., Betsy Shenkman, Ph.D., Jaclyn Hall, Ph.D., Hee Deok Cho, Ph.D., Yi Guo, Ph.D., Jiang Bian, Ph.D., Mike Gutter, Ph.D., Rahma Mkuu, Ph.D.

UF Health Cancer Center Catchment Area Profile

•

Coordinating Support Team Members: Jodian Blake, MPH, CTTS (Project Manager), Kali Bowen, TaJuana Chisholm, M.Ed, Ed.S., Alexandra Fahnlander, Kacey Finch, Marilee Griffin, Robert Houlihan, DHA, MBA, FACHE, CCRP, CRA, COA, LaTrina Massey, MPH, Ashley Sanders, M.S., Kathryn Shaw, MPH, Myra Smith, MPH, Jennifer Woodard, MPH, Janet Brishke, MPH, Xing He, M.S., Jessica Barton, MAMC, Liz Manini, M.S.A., Tianchen Lyu, M.S., Yanning Wang, M.S., and Duane Baker

8

Abbreviations

AC S AHEC BRFSS CAB CaRE2 CArea CCPS CDC CEnR CHW COE COPD CTHR DSG E&M EHR FA M U FCDS FQHC HPV MiCaRT MOO MRI NA ACP NCI NHB NHW PA C H E PCORI PORTRAIT PSA RUCC RWHP SCLC SES SEV SRMC SVI UF U F / I FA S UFHCC URM USC – NCC USC USPSTF

American Community Survey Area Health Education Center Behavioral Risk Factor Surveillance System Community Advisory Board Cancer Research, Education & Engagement Catchment Area Cancer Control and Population Sciences Centers for Disease Control Community-Engaged Research Community Health Worker Community Outreach & Engagement Chronic obstructive pulmonary disease Cancer Therapeutics & Host Response Disease Site Group Evaluation & Management Services Electronic Health Records Florida Agricultural and Mechanical University Florida Cancer Data System Federally Qualified Health Center Human Papillomavirus Minority Cancer Research and Training Center Mechanisms of Oncogenesis Magnetic Resonance Imaging National Association for the Advancement of Colored People National Cancer Institute Non-Hispanic Black Non-Hispanic White Partnerships to Advance Cancer Health Equity Patient-Centered Outcomes Research Institute Partnerships to Optimize and Transform Research through Action and Impact Together Prostate-specific Antigen Rural Urban Continuum Codes Rural Women's Health Project Small Cell Lung Cancer Socioeconomic Status Socioeconomic Vulnerability Scientific Review and Monitoring Committee Social Vulnerability Index University of Florida UF Institute of Food and Agricultural Sciences University of Florida Health Cancer Center Underrepresented Minorities University of Southern California Norris Comprehensive Cancer Center University of Southern California US Preventive Services Task Force

UF Health Cancer Center Catchment Area Profile

18

19

Image provided by Gainesville Community Redevelopment Association

UF Health Cancer Center Catchment Area Profile

2

UF HCC C ATC H M ENT AREA AND P OP UL ATION

UF Health Cancer Center Catchment Area Profile

20

1

The UFHCC Catchment Area

Figure 9: The UFHCC Catchment Area

8 14 23

10

16

11 21

20

6

12 7

2 22

9

1

15

18 17

4

T H E U F H C C C AT C H M E N T A R E A

5

3

19

13

is comprised of 23

contiguous counties in North Florida, with 2.3 million people. Residents from the catchment area account for 77.1% of the patients seen at UF Health Cancer Center, according to data from 2012-2018.

The 23 counties are spread over a land area of 17,494 square miles, greater than the area of Massachusetts, Rhode Island and Connecticut combined.

21

1. AL ACHUA

1 0 . H A M I LT O N

2. BAKER

11. JEFFERSON

3. BRADFORD

1 2 . L A FAY E T T E

4. CITRUS

13. LAKE

5 . C L AY

14. LEON

19. SUMTER

6. COLUMBIA

15. LEVY

2 0 . S U WA N N E E

7. D I X I E

16. MADISON

2 1 . TAY L O R

8. GADSDEN

1 7. M A R I O N

22. UNION

9. GILCHRIST

18. PUTNAM

2 3 . WA K U L L A

UF Health Cancer Center Catchment Area Profile

2

Catchment Area Population in Perspective

BELOW ARE SOM E DEFI N I NG CHAR ACTERISTIC S

of our catchment area population. Note that

health inequities may be magnified when considering intersections among population characteristics. Unique aspects of the UFHCC catchment area population compared to Florida and the United States include:

23.2% 16.4%

9.8%

65 OR OLDER

BLACK

HISPANIC

16.3%

OVERALL POVERTY

Our catchment area is home to a higher percentage of adults aged 65 years and older compared to Florida overall (23% vs. 20%).

The areas with the highest percent of individuals who are 65 and older are in the southern part of our catchment area—small metro counties to the south of Gainesville.

Individuals who identify as Black comprise 16.4% of our catchment area population overall, but account for 21% in rural counties.

Gadsden county, in the northwest of our catchment area, is the only county in Florida with a majority Black population. Throughout the catchment area, the percentage of people who identify as Black is comparable to state levels of about 16%.

Hispanics/Latinos account for 18% of the U.S. population and 26% of the Florida population, but only 10% of the population in the UFHCC catchment area. The Hispanic/Latino population is small but has grown 25% (from 7.5% to 10%) within our catchment area since 2010. The relatively younger age of this population corresponds to lower cancer rates compared to the non-Hispanic white and Black population.

Poverty rates in the catchment area are highest in rural areas (19%) compared to the overall rate in the catchment area (16%), Florida (14%) and the U.S. (13%). Five of the six counties in Florida that are defined as counties with persistent poverty are located in the UFHCC catchment area. Persistent poverty is defined by the USDA as counties with poverty rates of 20% or more for the past 30 years, as measured by the past three decennial censuses.

UF Health Cancer Center Catchment Area Profile

22

3

Key Definitions

RURALITY AND SMALL METRO Figure 10: The Rural and Small Metro (Non-Rural) Counties in the UFHCC Catchment Area

RURAL COUNTIES

Baker Bradford Columbia Dixie Gadsden Gilchrist

Hamilton Jefferson Lafayette Levy Madison Putnam

Suwannee Taylor Union Wakulla

S M A L L- M ET R O CO U N T I E S = Rural = Small-metro

Alachua Citrus Clay

Lake Leon Marion

Sumter

= UFHCC

The State of Florida uses a specific definition for many of its departments and legislative initiatives that is based on population density and adjacency to other rural and economically distressed counties.

Section 288.0656, Florida Statutes, defines a rural county as: 1. A county with a population of 75,000 or less 2. A county with a population of 125,000 or less which is contiguous to a county with a population of 75,000 and shows at least three or more economic distress factors. (7) Using this definition, we can observe the following about our catchment area: The UFHCC catchment area includes no counties that are considered by RUCC to be Large Metropolitan (counties with metro areas of > 1 million population).

The catchment area contains four counties with a population < 500,000 and three counties with a population < 250,000 but not considered rural. These seven counties we will refer to as Non-Rural or Small Metropolitan (Small-metro). The remaining 16 counties are classified as Rural.

• •

23

UF Health Cancer Center Catchment Area Profile

There is no one single method to categorize rurality, but one of the first national systems of rurality classifications were the Rural Urban Continuum Codes (RUCC) for all U.S. counties created in the 1970s (5) by the USDA’s Economic Research Service. (6) Several cancer centers have used the county RUCC classifications to describe their cancer catchment area.

The geographic analysts at the UFHCC have found that RUCC classification does not appropriately describe the rural-urban distribution in Florida, an elongated peninsular state with a high density of super highways and a high density of poor families, even in rural areas.

SOCIOECONOMIC VULNERABILITY (SEV) Figure 11: Socioeconomic Vulnerability in the UFHCC Catchment Area

= 0.77 - 1.00

= 0.51 - 7.6

= 0.26 - 0.50

= 0.00 - 0.25

Data Source: CDC Social Vulnerability Index, 2018 Note: Ranked by whole US tracts

• • • •

•

•

The Centers for Disease Control (CDC) social vulnerability index (SVI) “refers to the resilience of communities when confronted by external stresses on human health.” (8) Social Economic Vulnerability (SEV) is part of the CDC’s SVI score, and includes census-tract level measures of poverty, unemployment, income, and education.

This census tract-based measure provides important population-level context for understanding the UFHCC catchment area.

Throughout this report, we will organize cancer and population statistics by rural status as well as SEV, and note relevant findings related to high SEV and low SEV areas, especially as they relate to patterns of inequity by gender, race, and/or ethnicity.

Analyzing data below the county level—that is, using SEV in addition to rural/non-rural status is insightful for addressing inequities in our catchment area as we see clusters of high SEV census tracts in both rural and the small metro counties. For example, Alachua County, home of the UFHCC, has high SEV and persistent poverty concentrated on the east side of the county with the westside experiencing relative affluence.

Calculating the age-adjustment for breakdowns of SEV requires data from Census.gov that are not available at the census tract level for the NHB population. Therefore, statistics related to high and low SEV cancer incidence are given for white and black populations, without the intersection with Hispanic ethnicity. In our catchment the Hispanic population, although growing, is currently small.

There is very little difference between- white and black compared to NHW and NHB cancer incidence rates.

KEY DEFINITIONS HIGH SEV refers to the census tracts with the most vulnerability—the top 50% or top two quartiles of the CDC’s SEV measure.

LOW SEV refers to the census tracts with the least vulnerability—the bottom 50% or the bottom two quartiles of the CDC’s SEV measure.

UF Health Cancer Center Catchment Area Profile

24

SOCIOECONOMIC VULNERABILITY (SEV) IN THE UFHCC CATCHMENT AREA

The UFHCC Catchment Area has been divided into High SEV and Low SEV—with high vulnerability indicating those areas that have worse measures of poverty, unemployment, income, and education compared to areas with low vulnerability.

43.3%

of residents live in areas with the highest SEV.

GENDER

MALE

FEMALE

44.4%

42.2%

of men live in high vulnerability neighborhoods

of women live in high vulnerability neighborhoods

55.6%

57.8%

of men live in low vulnerability neighborhoods

of women live in low vulnerability neighborhoods

SEV Index: Centers for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry, CDC Social Vulnerability Index, 2018; https://www.atsdr.cdc.gov/placeandhealth/svi/index.html

25

UF Health Cancer Center Catchment Area Profile

RACE WHITE

BLACK

4 out of 10 whites live in high SEV neighborhoods

6 out of 10 Blacks live in high SEV neighborhoods

6 out of 10 whites live in low SEV neighborhoods

4 out of 10 Blacks live in low SEV neighborhoods

RACE & GENDER

40.9% of white men live in high SEV neighborhoods

38.8%

of white women live in high SEV neighborhoods

62.4% of Black men live in high SEV neighborhoods

60.3%

of Black woman live in high SEV neighborhoods

Calculating the age-adjustment for breakdowns of SEV requires data from Census.gov that are not available at the census tract level for the NHB population. Therefore, statistics related to high and low SEV cancer incidence are given for white and black populations, without the intersection with Hispanic ethnicity. In our catchment the Hispanic population, although growing, is currently small. There is very little difference between- white and black compared to NHW and NHB cancer incidence rates.

UF Health Cancer Center Catchment Area Profile

26

Focus on SEV in Alachua County Figure 12: Socially Vulnerable within Alachua County LOW HIGH The Office of Community Outreach and Engagement recognizes that education, research, partnerships and interventions will be more effective and sustainable the more attention is given to local context beyond macro-level statistics. That is, disparities related to race/ethnicity, income, education, the built environment are geographically patterned not only within counties, but also within zip codes and socially-defined neighborhoods. For example, within Alachua county, the home of the UF Health Cancer Center, significant disparities exist between the east and west sides of Gainesville. The important work of documenting community context has been undertaken = 1.086 - 1.789 = 0.393 - 1.085 in Alachua county by a multi-sector consortium in = 1.790 - 2.622 = 2.969 - 3.568 = 2.623 - 2.968 Gainesville called the Friendship Seven.

Addressing Racial Inequity through Local Community Action The Friendship Seven, a partnership consisting of University of Florida, UF Health, Santa Fe College, the City of Gainesville, Gainesville Area Chamber of Commerce, Alachua County and Alachua County Public Schools, commissioned a report (9) on the history and current state of racial inequity in Alachua county in 2018. Additional support for the project and its local dissemination has been provided by the Racial Justice Task Force of the United Church of Gainesville and the Alachua County Branch of the NAACP. The report was conducted by the Bureau of Business and Economic Research at UF and provides extensive information on how Black residents in the county fare worse than other racial/ethnic groups across seven areas—economic well-being, education, family structure, child welfare, interactions with the justice system, housing and transportation. The report states, “By gaining a more thorough understanding of [racial inequity], community leaders will be better equipped to influence institutional awareness, make policy recommendations that support initiatives that tackle the causes of these problems, resulting in a reduction in these disparities.” (9)

27

UF Health Cancer Center Catchment Area Profile

Figure 13: Black Population as Percent of Total

> 5%

5% - 10%

10% - 20%

20% - 30%

30% - 96%

Image Source: “Understanding Racial Inequity in Alachua County”

by Hector H. Sandoval, 2018

The Friendship Seven report provides important context about the disparities and inequities that are geographically proximate to the UF Health Cancer Center and identifies important opportunities for building trust and co-creating programs in Gainesville using the principles of community-engaged research (1, 2, 4).

4

An Integrative & Intersectional Framework

T H R O U G H O U T T H I S R E P O R T,

we encourage the use of a multifaceted framework of intersectionality to

understand the unique, overlapping burdens of our population. This integrative and intersectional framework is especially important when examining advanced stage diagnoses and mortality, which is a particularly high burden in our catchment area, compared to the state of Florida.

AGE

INCOME

E D U C AT I O N

R ACE

GENDER

RURALITY

INTERSECTIONAL FRAMEWORK An intersectional framework encourages researchers to examine health inequities as overlapping systems of hardship that are placed upon an individual, recognizing that multiple characteristics (such as age, gender, race, ethnicity, rurality, and socio-economic status) may place individuals and populations at increased risk for being marginalized in society (10, 11). Intersectionality encourages an understanding that social categories (e.g., race, socioeconomic status, gender, sexual orientation) are not independent and unidimensional but rather multiple, interdependent and mutually constitutive.

SOCIAL DETERMINANTS OF HEALTH “Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (12).

RURAL & SMALL METRO Sixteen of our 23 counties are classified as rural according to Section 288.0656, Florida Statutes (7), comprising 24% of all Florida counties. The remaining counties are classified as Small Metro or Non-Rural.

SOCIOECONOMIC VULNERABILITY (SEV) “Socioeconomic Vulnerability is a census tract-based measure that uses poverty, unemployment, income, and education levels to designate areas of potential negative effects on communities caused by…stresses on human health” (8) The UFHCC catchment area has many areas of high SEV.

UF Health Cancer Center Catchment Area Profile

28

USING AN INTERSECTIONAL FRAMEWORK TO UNDERSTAND CANCER BURDEN Table 1: Advanced Stage Cancer Incidence

CArea CArea LOW SEV HIGH SEV

ALL RACES

WHITE

BLACK

HISPANIC

FL

204.5

207.5

213.7

163.3

CArea

218.4

222.8

212.0

155.4

Non-Rural

217.9

222.7

209.5

155.1

Rural

218.0

220.9

218.1

150.8

Low SEV

203.3

207.1

196.9

142.7

High SEV

238.7

246.2

222.5

173.3

Non-Rural

202.2

206.6

189.0

146.2

Rural

210.7

209.9

237.7

93.7

Non-Rural

245.7

253.4

229.0

175.9

Rural

226.5

233.0

214.6

169.3

Data Source: Average annual age-adjusted advanced stage incidence, per 100,000 population, FCDS 2013-2017 Explanation of Color Scale: The cell that holds the minimum value is colored the darkest blue. The 50th percentile was calculated (also known as median, middle value or midpoint), and the cell that holds the median value is colored white. Finally, the cell that holds the maximum value is colored the darkest orange. All other cells are colored proportionally.

Note: Bolded italics indicate small numbers in raw counts (n<30)

Rurality For all population data, it seems rurality does not have as great an impact upon advanced stage diagnosis compared to socioeconomic vulnerability.

SEV Areas with high socioeconomic vulnerability have higher rates of advanced stage cancer incidence than low SEV areas.

Race & Rurality Although the advanced stage cancer incidence rate for whites is almost equal for those in rural and non-rural areas, for Black residents in our catchment, incidence rates are higher in rural areas compared to non-rural areas.

Race & SEV All race and ethnicity groups have higher rates of advanced stage diagnosis in high SEV areas vs. low SEV areas.

Race & Rurality and SEV Overall, the catchment area sees highest rates of advanced stage diagnosis among communities designated as high SEV within non-rural counties.

29

UF Health Cancer Center Catchment Area Profile

Important Note on Small Numbers There is an unequal distribution of the racial and ethnic groups of the catchment area population in rural/non-rural and high/low SEV areas. Tables such as the one above may create cells with low raw counts as we investigate the intersections of multiple, overlapping categories. Small numbers can lead to unstable (very high or low) rates. For example, due to the greater poverty (high SEV) in rural areas, there are relatively few low-SEV communities in rural areas, and we see especially low numbers for Black or Hispanic residents within low-SEV rural areas. UFHCC researchers are encouraged to pay attention to groups that are underserved and/or traditionally underrepresented in research, however, small numbers must be interpreted with a degree of caution. In addition, given that the Hispanic/Latino population in the catchment area is relatively small compared to the state, caution is urged in interpreting data specific to this group. Throughout this report, we will note where small numbers exist to aid readers in the interpretation of the data. Blank cells indicate a rate was not calculated due to an n<16, and italics indicate a raw count <30.

5

Basic Demographics of the Catchment Area

T H E U F H E A LT H C A N C E R C E N T E R C AT C H M E N T A R E A

is characterized by the following demographic

characteristics, as compared to state and national rates: Figure 14: Demographic Characteristics of UFHCC Catchment Area

Data Source: U.S. Census Bureau, 2019, Population Estimation: Age and Sex, ACS 5-Year Estimates; U.S. Census Bureau, 2019, Poverty Status in the Past 12 Months, ACS 5-Year Estimates

Table 2: Basic Demographic Characteristics of the UFHCC Catchment Area US

FL

CArea

CArea NON-RURAL

CArea RURAL

FEMALE

50.8%

51.1%

50.7%

51.6%

47.7%

NHW

60.7%

53.9%

69.4%

69.3%

69.5%

NHB

12.3%

15.3%

16.0%

14.7%

20.7%

HISPANIC

18.0%

25.6%

9.8%

10.5%

7.2%

AGE 65+

15.6%

20.1%

23.2%

24.4%

19.3%

POVERTY

13.4%

14.0%

16.3%

15.5%

19.3%

Data Sources: U.S. Census Bureau, 2019, Population Estimation: Age and Sex, ACS 5-Year Estimates; U.S. Census Bureau, 2019, Poverty Status in the Past 12 Months, ACS 5-Year Estimates

• •

A greater percentage of people in the UFHCC catchment area identified as non-Hispanic white (NHW) (69%) compared to Florida and the U.S. (54% and 61%, respectively).

A similar percentage of catchment area residents identified as non-Hispanic Black (NHB) compared to the state of Florida (about 16%). Within the catchment area counties, more Black individuals live in rural areas (21%) compared to non-rural areas (15%).

• • •

A smaller percentage of individuals who are Hispanic (10%) compared to Florida and the U.S. (26% and 18%, respectively).

Our catchment area has a greater number of individuals aged 65 or older (23%), compared to the state of Florida (20%) and the U.S. (16%).

Poverty rates in the catchment area are about 16% of residents, higher than those in the state and U.S. (14% and 13%).

UF Health Cancer Center Catchment Area Profile

30

AGE DISTRIBUTION IN THE CATCHMENT AREA Figure 15: Population by Age Group 35 30 25 20 15 10 5 0 Under 20

Age 20-44 US

FL

Age 45-64

CArea

CArea Rural

Age 65+

CArea Non-Rural

Data Source: U.S. Census Bureau, 2019, Population Estimation: Age and Sex, ACS 5-Year Estimates

Figure 16: Population Change over Time for Individuals Aged 65 or Older, 2010-2019 24% 22% 20% 18% 16% 14% 12% 10% 2010

2011

2012

2013

2014 US

2015 FL

2016

2017

2018

2019

CArea

Data Source: U.S. Census Bureau, 2010-2019, Population Estimation: Race and Ethnicity, ACS 5-Year Estimates

• •

31

A higher percentage of individuals aged 65 and older reside within the UFHCC catchment area compared to the state and the US. The proportion of retirement-age people has steadily increased over the last ten years in the catchment area, from about 18% to 23%.

UF Health Cancer Center Catchment Area Profile

•

The largest percentage of people 65 and older live in non-rural areas of our catchment area, with concentrations in the southern counties where large retirement communities are located.

POVERTY LEVELS The UFHCC catchment area has 16 out of 23 counties designated as rural, comprising 53% of the state’s rural counties. Thirteen of these rural counties are above the state poverty rate of 14%. Four of the non-rural counties have poverty rates above the state rate.

Figure 17: Catchment Area County-Level Poverty Rates

=

=

State Poverty Rate (14%)

Data Source: U.S. Census Bureau, 2019, Poverty Status in the Past 12 Months, ACS 5-Year Estimates

UF Health Cancer Center Catchment Area Profile

32

Figure 18: Percent Poverty Rates

Data Source: U.S. Census Bureau, 2019, Poverty Status in the Past 12 Months, ACS 5-Year Estimates

•

Almost 75% of the catchment area counties have poverty rates higher than the state rate of 14%.

•

About 1 in 5 individuals are living at or below 100% of the Federal Poverty Level within the UFHCC catchment area’s rural counties.

EDUCATIONAL ATTAINMENT Figure 19: Educational Attainment of Individuals Aged 25+, High School or Less

Data Source: U.S. Census Bureau, 2019, Educational Attainment, ACS 5-Year Estimates

•

33

UFHCC catchment area residents aged 25 and older have slightly higher rates of attaining a HS degree or less compared to state and national rates.

UF Health Cancer Center Catchment Area Profile

•

Rural areas of the catchment have a pronounced burden of less educational attainment compared to non-rural areas.

6

Minority Group Populations

Figure 20: Minority Population Trends, 2010-2019

Data Source: U.S. Census Bureau, Population Estimation: Race and Ethnicity, ACS 5-Year Estimates, 2010-2019

•

The percent of the Hispanic/Latino population showed an increasing trend, from 7.5% to 10%, an increase of 25% since 2010.

•

The percent of the Black population has been similar over the past 10 years, at about 16%.

HISPANIC/LATINO POPULATION IN THE UFHCC CATCHMENT AREA

•

•

Hispanics account for 18% of the U.S. population and 26% of the Florida population, but only 10% in the UFHCC catchment area.

This population is small but has grown 25% (from 7.5% to 10%) within our catchment area since 2010.

The relatively younger age of this population corresponds to overall lower cancer rates compared to the non-Hispanic white and Black population. However, relatively small numbers of this group in the catchment area mean that caution is required when examining cancer rates. See “Important Note on Small Numbers” on page 27 for more information.

•

Using an intersectional lens and an understanding of demographic information from the literature, we know that Hispanic and Latino populations are heterogenous groups that may be subject to multiple systems of discrimination and oppression. This group can be thought of as a “hidden” population, undercounted by the U.S. Census and underrepresented in large medical datasets due to their overall lack of insurance and inability to seek regular care.

UF Health Cancer Center Catchment Area Profile

34

7

Local Case Study: Access to Care among Latina Immigrants

UFHCC COMMUNITY ADVISORY BOARD PARTNERSHIP PROFILE: RURAL WOMEN’S HEALTH PROJECT MISSION

Rural Women’s Health Project (RWHP) uses evidence-based strategies to build sustainable and replicable community programs and policies to strengthen communities’ capacity to overcome health and social justice barriers. Founded in 1991, the RWHP involves communities in the development and implementation of research findings. We seek to build the capacity of emerging leaders, create advocacy opportunities, build coalitions and improve linkage to health protective services.

RWHP PRIORITY POPULATIONS

1. Latino Immigrants (Marion, Alachua, Levy and Gilchrist) 2. Women living with HIV in North Central Florida

PROGRAMS

1. Project SALUD referral and navigation Spanish-language line 2. Let’s Talk About It — advocacy/support program for women living with HIV 3. Salir Adelante Latina Youth Internship Program 4. Family Separation in the Sunshine State initiative to end detention/foster care outcomes for children 5. North Central Florida Social Service/ Hispanic Alliance

I N 2 0 2 0 , K A E L I F L A N N E R Y, M P H , A N D R O B I N L E W Y, M A ,

of the Rural Women’s Health Project conducted

a Participatory Community Assessment to identify barriers to medical and social services among Latina immigrants in North Florida. The results from this Community Assessment are reproduced with permission of RWHP and are based on responses from 93 Latina immigrants living in Alachua, Levy and Marion counties. While they provide critical insights into the demographics, health and social challenges in the community, these findings should not be interpreted as representing the experiences of all Latina immigrants. Rather, these findings offer a snapshot of the various challenges impacting access to services.

35

UF Health Cancer Center Catchment Area Profile

DEMOGRAPHIC HIGHLIGHTS Figure 21: Countries of Origin for Study Sample (n=93)

Age 43% are aged 25 to 35 years old Education 51% received a primary school education or less Marital Status 64% are married or in a cohabiting relationship

GREATEST CONCERNS IN THE COMMUNITY While this assessment revealed the importance of health and wellbeing to the Latina immigrant community, it also showed how health is prioritized in light of other factors.

Barriers to Care Insurance status represents one of the greatest barriers to care, with 94% of women stating they are uninsured. This is more than 11 times the average for women in the United States (13). When selecting a clinic, women stated the most important factors were Spanish translation, cost of services and feeling respected.

Top 3 Community Concerns: 1. Immigration Stressors (30%) 2. Health Resources (22%) 3. Employment (11%)

Figure 22: Barriers to Medical and Social Services for Latinas

UF Health Cancer Center Catchment Area Profile

36

PRIMARY CARE & SCREENING Figure 23: Difficulty Accessing Medical Care by Service Category among Latinas

Eighteen percent of women have no regular primary care provider. An additional 71% rely on safety net providers (e.g., mobile clinics, health departments and Federally Qualified Health Centers, or FQHCs) for regular care.

A lack of continuous care can result in the inability to follow recommended screening guidelines and can lead to late entry to care: 88% of women reported difficulty accessing at least one medical service. Moreover, almost one quarter of women reported difficulty accessing preventive care.

Women’s health care, including cancer screenings, were among the most difficult service to access as evidenced by 39% of women. This was also reflected in access to screening: 18% of women were overdue for a Pap smear exam and an additional 20% never had a pap smear exam.

Among women over 40 years of age, 31% were overdue for a mammogram.

37

UF Health Cancer Center Catchment Area Profile

Figure 24: Types of Regular Primary Care Providers for Latinas

PHYSICAL & BEHAVIORAL HEALTH COMPARED TO YEARS IN THE U.S. Figure 25: Self-rated Physical and Emotional Health by Years in the U.S. for Latinas

When considering how the number of years in the U.S. impacts Latina immigrant health the survey findings suggest as years in the U.S. increase, behavioral/emotional and physical health decline.

When comparing new arrivals (0-2 years in U.S.) to long-term residents (11-25 years), there was a 43% decrease in good physical health and a 51% decrease in good emotional health.

The barriers to care, as discussed previously, do not significantly differ across years in the U.S. However, as numerous studies have demonstrated (14), prolonged exposure to the traumas of immigration status negatively impacts physical and emotional health. In this survey, 85% of women were fearful of family separation and 62% lived in a mixed legal status household.

COUNTY COMPARISON OF NEEDS FOR PRIMARY CARE AND CANCER SCREENINGS Figure 26: Requested Medical Services by County for Latinas

This community assessment offered linkage to medical services for all participants. When stratified by county, particular gaps in care were illuminated. One hundred percent of women in Levy county requested primary care, as compared to 74% in Alachua and 52% in Marion counties. With regard to cancer screenings that women desired, most notable findings were that 91% of women in Levy County requested a pap smear and 70% in Alachua County requested a mammogram.

Strikingly, in terms of needs for cervical and breast cancer screenings, 91% of women requested Pap smears in Levy County as compared to 61% in Alachua and 38% in Levy.

Twenty percent of women had never had a Pap test.

UF Health Cancer Center Catchment Area Profile

38

39

UF Health Cancer Center Catchment Area Profile

3 C A NC ER I N TH E UF HCC C ATC H M ENT AREA

UF Health Cancer Center Catchment Area Profile

40

1

Incidence, Advanced Stage Cancer Incidence and Mortality Rates

OVER A L L , TH E UF HCC

has higher age-adjusted cancer incidence than the state of Florida and the

U.S. The catchment area also has higher age-adjusted advanced cancer incidence and mortality rates compared to state and national rates (Note: Advanced stage diagnosis incidence data not available for the U.S.).

Table 3: Cancer Incidence, Advanced Stage Cancer Incidence, and Mortality Rates per 100,000 OVERALL CANCER INCIDENCE, 2013-2017

US*

FL**

CArea

448.7

494.9

509.9

204.5

218.4

147.0

166.0

ADVANCED STAGE CANCER INCIDENCE, 2013-2017 MORTALITY, 2014-2018

158.3

*For U.S. Incidence & Mortality: CDC, 2013-2017, United States Cancer Statistics ** For FL and catchment area Incidence: FCDS, 2013-2017 and Mortality: FDOH, 2014-2018, FLHealthCharts – Death Count Query System Average Annual Age-Adjusted Cancer Incidence and Mortality per 100,000 Population; CDC does not provide advanced stage cancer incidence data

Figure 27: Cancer Incidence, Advanced Stage Cancer Incidence, and Mortality Rates

US

FL

CArea

*For U.S. Incidence & Mortality: CDC, 2013-2017, United States Cancer Statistics ** For FL and catchment area Incidence: FCDS, 2013-2017 and Mortality: FDOH, 2014-2018, FLHealthCharts – Death Count Query System Average Annual Age-Adjusted Cancer Incidence and Mortality per 100,000 Population; CDC does not provide advanced stage cancer incidence data

KEY DEFINITIONS: AGE-ADJUSTED RATES Why do we age adjust the data? Age-adjusting the rates ensures that differences in incidence or deaths from one year to another, or between one geographic area and another, are not due to differences in the age distribution of the populations being compared.

41

UF Health Cancer Center Catchment Area Profile

RATES BY COUNTY

• • • •

•

Figure 28: Annual Average Age-adjusted Cancer Incidence per 100,000 Population, 2013-2017

Eleven counties in the UFHCC catchment area have higher cancer incidence than overall state rates.

Fourteen counties in the catchment area have higher advanced stage incidence than the state incidence rates.

Of those 14 counties with high advanced stage diagnosis rates, 9 counties are designated as rural counties.

Advanced stage incidence rates in the catchment area point to a need for translational research that can lead to impactful interventions.

Rural counties to the north and west of the UFHCC showed the highest mortality from cancer.

*

UN IVERSIT Y OF FLORI DA Gainesville, FL

= 288 - 422

= 423 - 465

= 466 - 500

= 501 - 541

= 542 - 631

Data Source: FCDS, 2013-2017 *Union County (1180) is an outlier due to state prison cancer center

Figure 29: Annual Average Age-adjusted Advanced Stage Cancer Incidence per 100,000 Population, 2013-2017

Figure 30: Annual Average Age-adjusted Cancer Mortality per 100,000 Population, 2014-2018

*

*

= 88 - 189

= 107 - 143

= 190 - 197

= 144 - 156

= 198 - 215

= 157 - 171

= 216 - 224

= 172 - 181

= 225 - 260

= 182 - 210

Data Source: FCDS, 2013-2017 *Union County (578) is an outlier due to state prison cancer center

Data Source: FDOH, FLHealthCharts, 2014-2018 *Union County (448) is an outlier due to state prison cancer center

UF Health Cancer Center Catchment Area Profile

42

CANCER INCIDENCE: AN INTERSECTIONAL ANALYSIS This section explores patterns of cancer incidence by gender, race and ethnicity, as well as by geographic designations of rural/ non-rural* and low/high socioeconomic vulnerability** (SEV). The data for the various populations in the UFHCC catchment area highlight the importance of using an intersectional framework for interpretation. This intersectional lens, defined above in the Key Definitions section, allows researchers to unpack some of the layers of social and structural discrimination and privilege that population groups experience.

• • •

•

The highest rates of cancer incidence for all sites are found in areas designated as high SEV and non-rural.

Overall, the male population has higher cancer incidence than the female population.

The white population showed higher incidence than Black and Hispanic populations, which is likely due to the lower overall age of the latter two population groups within the UFHCC catchment area.

Looking across multiple variables, some patterns emerge for cancer incidence—a concern within the UFHCC catchment area as the catchment area rates are higher than in Florida and the US.

WOMEN

The highest rates of cancer incidence are among women living in areas designated as high SEV and non-rural.

White women have high rates of incidence in high SEV non-rural areas Black women have the highest incidence rates in low SEV rural areas, although the low numbers* require additional scrutiny.

MEN

There are higher rates of incidence among men living in areas designated as high SEV and non-rural versus men living in other areas.

White men have the highest rates of incidence in high SEV non-rural areas.

Black men have the highest rates of cancer incidence in rural areas, and an overlap with high SEV areas compounds that burden for this population group.

*Low numbers in rural areas as defined by FL Statutes **SEV measures poverty, median income, education, and unemployment in census tracts (CDC)

FOR MORE INFORMATION Access the PORTRAIT online data portal for more data and for raw counts related to incidence, advanced stage diagnosis, as well as mortality.

43

UF Health Cancer Center Catchment Area Profile

Table 4: Cancer Incidence Rates by Race, Ethnicity, and Gender ALL CANCERS (ALL GENDERS) FCDS 2013-2017

CArea

CArea

LOW SEV

HIGH SEV

ALL RACES

WHITE

BLACK

HISPANIC

FL

494.9

506.3

461.1

370.0

CArea

509.9

518.7

454.0

338.3

Non-Rural

513.8

523.1

452.1

343.9

Rural

492.0

499.0

459.1

301.6

Low SEV

492.7

499.2

432.8

321.5

High SEV

520.8

534.0

464.5

360.1

Non-Rural

493.8

501.2

424.7

328.5

Rural

480.9

482.4

480.0

227.2

Non-Rural

531.2

544.4

470.4

377.0

Rural

502.5

515.1

457.9

327.5

ALL RACES

WHITE

BLACK

HISPANIC

FL

470.1

484.7

428.9

352.5

CArea

480.6

495.4

408.4

328.5

Non-Rural

484.4

497.8

418.5

337.9

Rural

465.3

485.4

388.6

269.2

Low SEV

469.7

480.4

407.5

322.2

High SEV

485.9

507.1

409.5

336.6

Non-Rural

468.8

479.7

399.9

328.7

477.7

487.9

454.5

242.7

Non-Rural

495.4

512.6

433.8

355.8

Rural

469.5

497.3

377.0

289.5

ALL RACES

WHITE

BLACK

HISPANIC

FL

531.0

538.7

510.4

403.8

CArea

549.7

551.4

520.9

356.6

Non-Rural

552.3

557.1

503.5

358.4

Rural

532.1

522.7

566.8

335.8

Low SEV

523.3

525.3

468.4

326.2

High SEV

569.4

572.1

549.5

396.5

Non-Rural

526.6

530.2

461.4

334.4

Rural

490.7

482.3

538.4

222.0

Non-Rural

578.8

586.8

529.9

421.8

Rural

551.0

544.8

582.5

370.2

ALL CANCERS (FEMALE) FCDS 2013-2017

CArea

CArea

LOW SEV

HIGH SEV

Rural

ALL CANCERS (MALE) FCDS 2013-2017

CArea

CArea

LOW SEV

HIGH SEV

Data Source: Average annual age-adjusted incidence, per 100,000 population, FCDS 2013-2017 Note: Bolded italics indicate small numbers in raw counts (n<30)

UF Health Cancer Center Catchment Area Profile

44

ADVANCED STAGE INCIDENCE: AN INTERSECTIONAL ANALYSIS This section explores patterns of advanced stage cancer incidence by gender, race and ethnicity, as well as by geographic designations of rural/non-rural* and low/high socioeconomic vulnerability** (SEV).

The data for the various populations in the UFHCC catchment area highlight the importance of using an intersectional framework for interpretation. This intersectional lens, defined above in the Key Definitions section, allows researchers to unpack some of the layers of social and structural discrimination and privilege that population groups experience.

• • •

Overall, the male population has higher advanced stage incidence than the female population.

The white population showed higher incidence than Black and Hispanic populations within the UFHCC catchment area.

Looking across multiple variables, some patterns emerge for advanced stage diagnoses—a concern within the UFHCC catchment area as the catchment area rates are higher than in Florida.

WOMEN

Higher rates of advanced stage incidence among women living in areas designated as non-rural and high SEV compared to other areas.

White women have high rates of advanced stage incidence in high SEV rural and non-rural areas.

Black women have high advanced incidence rates in high SEV and non-rural areas. There is also some concern for Black women in low SEV rural locations, although the low numbers* require additional scrutiny.

MEN

Higher rates of advanced stage incidence among men living in areas designated as non-rural and high SEV. White men have high rates of advanced stage incidence in high SEV rural AND non-rural areas—but with higher in non-rural areas.

Black men have high rates in high SEV and rural areas although the low numbers require additional scrutiny.

*Low numbers in rural areas as defined by FL Statutes **SEV measures poverty, median income, education, and unemployment in census tracts (CDC)

FOR MORE INFORMATION Access the PORTRAIT online data portal for more data and for raw counts related to incidence, advanced stage diagnosis, as well as mortality.

45

UF Health Cancer Center Catchment Area Profile

Table 5: Advanced Stage Cancer Incidence Rates by Race, Ethnicity, and Gender ADV. STAGE (ALL GENDERS) FCDS 2013-2017

CArea

CArea

LOW SEV

HIGH SEV

ALL RACES

WHITE

BLACK

HISPANIC

FL

204.5

207.5

213.7

163.3

CArea

218.4

222.8

212.0

155.4

Non-Rural

217.9

222.7

209.5

155.1

Rural

218.0

220.9

218.1

150.8

Low SEV

203.3

207.1

196.9

142.7

High SEV

238.7

246.2

222.5

173.3

Non-Rural

202.2

206.6

189.0

146.2

Rural

210.7

209.9

237.7

93.7

Non-Rural

245.7

253.4

229.0

175.9

Rural

226.5

233.0

214.6

169.3

ALL RACES

WHITE

BLACK

HISPANIC

FL

192.2

194.8

203.7

151.3

CArea

200.8

206.1

192.1

144.2

Non-Rural

201.0

205.7

196.4

144.3

Rural

199.5

206.7

183.7

141.1

Low SEV

187.3

191.4

184.1

131.8

High SEV

219.9

229.2

198.4

163.1

Non-Rural

185.2

189.6

177.1

134.1

Rural

203.8

205.7

222.8

Non-Rural

228.4

236.3

214.3

165.0

Rural

205.0

216.2

177.5

163.4

ALL RACES

WHITE

BLACK

HISPANIC

FL

221.0

224.3

229.9

182.7

CArea

240.2

243.4

239.8

170.7

Non-Rural

238.8

243.5

229.7

170.4

Rural

240.2

237.9

266.1

163.2

Low SEV

222.9

226.3

213.6

156.9

High SEV

262.5

267.3

257.6

186.7

Non-Rural

222.7

227.1

206.2

161.9

Rural

220.5

216.4

268.9

Non-Rural

267.9

275.1

252.4

189.4

Rural

251.9

252.6

268.5

184.7

ADV. STAGE (FEMALE) FCDS 2013-2017

CArea

CArea

LOW SEV

HIGH SEV

ADV. STAGE (MALE) FCDS 2013-2017

CArea

CArea

LOW SEV

HIGH SEV

Data Source: Average annual age-adjusted advanced stage incidence, per 100,000 population, FCDS 2013-2017 Bolded italics indicate small numbers in raw counts (n<30); Blank cells indicate small numbers in raw counts (n<16)

UF Health Cancer Center Catchment Area Profile

46

MORTALITY: AN INTERSECTIONAL ANALYSIS This section explores patterns of cancer mortality by gender, race and ethnicity, as well as by geographic designations of rural/ non-rural* using Florida Health Charts data from their Death Count Query System. There are no data for socioeconomic vulnerability (SEV) for mortality. The data for the various populations in the UFHCC catchment area highlight the importance of using an intersectional framework for interpretation. This intersectional lens, defined above in the Key Definitions section, allows researchers to unpack some of the layers of social and structural discrimination and privilege that population groups experience.

• •

•

Overall, rural areas have the highest mortality compared to non-rural areas.

The white population has higher mortality rates than do Black and Hispanic populations within the UFHCC catchment area. Men have higher mortality than women.

Looking across multiple variables, some patterns emerge for mortality—a concern within the UFHCC catchment area as the catchment area rates are higher than in Florida.

WOMEN

There are higher rates of mortality among women living in rural areas compared to other areas.

White women have the highest rates of mortality compared to Black and Hispanic women when considering the catchment area in its entirety.

White and Black women have the highest mortality rates in rural areas, but Hispanic women have the lowest mortality rates in rural areas compared to non-rural areas, although the low numbers* require additional scrutiny.

MEN

Men have higher mortality rates in rural areas compared to non-rural areas.

Black men have the highest mortality rates from cancer compared to white and Hispanic men when considering the catchment area in its entirety.

When distinguishing among men living in rural areas, White men have the highest rates of mortality in the catchment area compared to Black and Hispanic men.

Low numbers in rural areas as defined by Fl Statutes **SEV measures poverty, median income, education, and unemployment in census tracts (CDC), and SEV is not provided for Mortality rates

FOR MORE INFORMATION Access the PORTRAIT online data portal for more data and for raw counts related to incidence, advanced stage diagnosis, as well as mortality.

47

UF Health Cancer Center Catchment Area Profile

Table 6: Cancer Mortality Rates by Race, Ethnicity, and Gender MORTALITY (ALL GENDERS)

ALL RACES

WHITE

BLACK

HISPANIC

FL

147.0

147.8

150.3

111.7

CArea

166.0

168.6

164.2

103.0

Non-Rural

157.4

159.8

154.4

102.7

Rural

199.0

204.0

185.7

103.6

MORTALITY (FEMALE)

ALL RACES

WHITE

BLACK

HISPANIC

FL

125.1

125.3

129.2

91.4

CArea

136.3

138.7

132.5

88.8

Non-Rural

130.4

132.4

126.1

91.6

Rural

159.8

164.7

148.1

69.7

ALL RACES

WHITE

BLACK

HISPANIC

FL

174.3

175.2

182.1

141.5

CArea

201.4

203.6

210.6

120.2

CArea

CArea

MORTALITY (MALE)

CArea

Non-Rural

189.7

192.1

195.9

116.9

Rural

244.8

248.5

240.8

133.9

Data Source: Annual average mortality from cancers, FDOH 2014-2018, FL Health Charts – Death Count Query System

2

Top Cancers in the UFHCC Catchment Area

CONSIDERING ALL CANCER SITES,

the UFHCC catchment area has higher rates of incidence, advanced

stage incidence and mortality compared to state and national rates. It is also possible to see patterns among the top cancers within the catchment area compared to state and national rates.

•

•

•

Among top cancers, lung, colorectal, melanoma, oropharyngeal, kidney, pancreas, ovary, uterine, and cervical cancers showed higher age-adjusted incidence and/or advanced stage incidence in the catchment area relative to FL and U.S. The catchment area has higher advanced stage cancers than Florida for most top cancers, except breast, blood** and prostate, where there are lower rates in the catchment area than the state.

Mortality for lung, blood, colorectal, bladder and esophageal cancers are higher in the 23

•

counties that the UFHCC serves than for Florida and the U.S. Only lung, breast, colorectal and cervical cancers have evidence-based screening recommendations backed by the National Cancer Institute (NCI) and the U.S. Preventive Services Task Force (USPSTF). As these cancers are among the top advanced stage diagnoses in the catchment area, research and interventions that support screening are a priority for the UFHCC.

UF Health Cancer Center Catchment Area Profile

48

Table 7: Top Ten Cancer Incidence, Advanced Stage Incidence, and Mortality in the UFHCC Catchment Area INCIDENCE RANK

CANCER SITE OR TYPE

CArea

FL

US

All Sites

509.9

494.9

448.7

1

Breast

122.9

121.6

125.9

2

Prostate

96.0

98.5

104.5

3

Lung

71.2

60.2

58.3

4

Colorectal

40.6

40.0

38.4

5

Hematologic/Blood

40.5

41.5

—

6

Melanoma

26.6

25.2

22.3

7

Uterine

25.7

25.6

26.1

8

Bladder

19.5

19.5

20.0

9

Kidney

16.9

15.1

16.8

10

Oropharyngeal

16.0

14.5

12.4

CANCER SITE OR TYPE

CArea

FL

All Sites

218.4

204.5

A D VA N C E D I N C I D E N C E RANK 1

Lung

49.5

41.6

2

Breast

41.4

42.1

3

Hematologic/Blood

32.8

33.3

4

Colorectal

22.5

21.8

5

Prostate

18.5

18.5

6

Pancreatic

10.7

10.1

7

Oropharyngeal

10.4

9.1

8

Ovarian

8.6

8.2

9

Uterine

7.9

7.8

10

Cervical

5.0

4.6

CArea

FL

US

M O R TA L I T Y RANK

CANCER SITE OR TYPE

166.0

147.0

158.3

1

All Sites Lung

45.3

37.4

40.2

2

Breast

19.9

19.0

20.3

3

Prostate

17.3

16.5

19.1

4

Hematologic/Blood

15.6

14.3

—

5

Colorectal

15.1

13.1

13.9

6

Pancreatic

10.9

10.5

11.0

7

Ovarian

6.5

6.2

6.9

8

Liver

6.2

6.3

6.6

9

Bladder

4.9

4.3

4.4

10

Esophageal

4.9

3.6

3.9

Data Source: For U.S. Incidence & Mortality: CDC, 2013-2017, United States Cancer Statistics; for FL and catchment area incidence: FCDS, 2013-2017, and mortality: FDOH, 2014-2018, FLHealthCharts – Death Count Query System Average Annual Age-Adjusted Cancer Incidence and Mortality per 100,000 Population.

Note: 1) Blood cancers are comprised from Leukemia, Hodgkin’s Lymphoma, Non-Hodgkin’s Lymphoma, and Myeloma based on CDC SEER ICD-O-3 Cancer Classification Codes. These data are not available at the national level.

49

UF Health Cancer Center Catchment Area Profile

3

Effective Screening Recommendations

N C I A N D T H E U . S . P R E V E N T I V E S E R V I C E S TA S K F O R C E ( U S P S T F )

have outlined evidence-based

recommendations for cancers with effective screening tests. NCI defines tests as effective if they “find cancer early, reduce the chance that someone who is screened regularly will die from the cancer, and have more potential benefits than harms,” including iatrogenic side effects or disease, false positive and negative results, and overdiagnosis (15, 16).

All four of these recommended tests—for lung, breast, colorectal, and cervical cancers—address cancers in the UFHCC top ten for incidence, advanced incidence and/or mortality.

CANCER SITE OR TYPE

EFFECTIVE SCREENING TEST

NCI/USPSTF SCREENING GUIDELINES (16)

• LUNG

Low Dose Computed Tomography

• •

BREAST

Mammogram

C O L O R E C TA L

Colonoscopy, Sigmoidoscopy and Stool Tests

Biennial screening mammography for women aged 50 to 74 Women at higher risk for breast cancer may benefit more than average-risk women from beginning screening in their 40s

•

Screening for colorectal cancer starting at age 50 and continuing until age 75

• • C ERVIC A L

Adults aged 55 to 80 with a 30 pack-year smoking history and currently smoke or have quit within the past 15 years Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

Pap Test/Smear, HPV Test

•

Women aged 21 to 29, screening every 3 years with cervical cytology alone Women aged 30 to 65: Every 3 years with cervical cytology alone OR Every 5 years with high-risk human papillomavirus (hrHPV) testing alone OR Every 5 years with hrHPV testing in combination with cytology (cotesting) Does not recommend screening for under 21 or older than 65, women who had a hysterectomy with no history of precancerous lesions or cervical cancer.

• • •

USPSTF GRADE

B

B (C)

A

A

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-and-b-recommendations

UF Health Cancer Center Catchment Area Profile

50

Other screening tests may be indicated for individuals who are at an increased risk of cancer, but these tests do not meet NCI’s definition of effective. These tests are listed below.

CANCER SITE OR TYPE

TEST

BREAST

Breast MRI for women with BRCA1/BRCA2; clinical breast exams and regular breast self-exams

C O L O R E C TA L

Virtual colonoscopy

P R O S TAT E

PSA test

O VA R I A N

CA-125 test

O VA R I A N / E N D O M E T R I A L

Transvaginal ultrasound

LIVER

Alpha-fetoprotein blood test

MELANOMA

Skin exams

https://www.cancer.gov/about-cancer/screening/screening-tests

4

Site-specific Analysis of Cancer Incidence

COMPARISONS BY GENDER, RACE, AND ETHNICITY

• • •

51

Women in the UFHCC catchment area have higher incidence rates for lung, colorectal, melanoma, kidney, ovarian and pancreatic cancers, compared to the state incidence rates.

Men in the catchment area have incidence rates higher than state levels for lung, melanoma, oropharyngeal, pancreatic and liver cancers.

The UFHCC cancer incidence rates for lung, melanoma, kidney, and oropharyngeal cancers are higher compared to the state and national rates.

UF Health Cancer Center Catchment Area Profile

• •

Incidence in the catchment area’s Black population is marked by rates higher than state and national rates for pancreatic and oropharyngeal cancers.

The Hispanic population in the catchment area is small compared to the state and to the U.S., but it is growing. Incidence rates for this group are characterized by higher rates of ovarian cancer compared to state and national rates.

Table 8: Top Ten Cancer Incidence by Gender INCIDENCE (FEMALE) RANK CANCER SITE OR TYPE

CArea

FL

US

All Sites

480.6

470.1

422.2

1

Breast

122.9

121.6

125.9

2

Lung

60.7

52.8

51.3

3

Colorectal

35.9

34.8

33.7

4

Hematologic/Blood

32.4

33.8

—

5

Uterine

25.7

25.6

26.1

6

Melanoma

20.3

18.2

17.7

7

Thyroid

14.1

18.9

21.1

8

Kidney

12.2

10.5

11.7

9

Ovarian

11.8

11.5

10.9

10

Pancreatic

11.7

11.6

11.4

CArea

FL

US

All Sites

549.7

531.0

488.5

1

Prostate

96.0

98.5

104.5

2

Lung

83.6

69.2

67.5

3

Hematologic/Blood

49.5

50.5

—

4

Colorectal

45.8

46.0

43.9

5

Melanoma

34.4

33.9

28.6

6

Bladder

32.8

33.2

34.6

7

Oropharyngeal

25.7

22.8

18.9

8

Kidney

22.3

20.5

22.8

9

Pancreatic

16.1

15.4

14.7

10

Liver

13.5

12.7

12.9

INCIDENCE (MALE) RANK CANCER SITE OR TYPE

Data Source: For U.S. Incidence: CDC, 2013-2017, United States Cancer Statistics; For FL and catchment area incidence: FCDS, 2013-2017 Note: 1) Blood cancers are comprised from Leukemia, Hodgkin’s Lymphoma, Non-Hodgkin’s Lymphoma, and Myeloma based on CDC SEER ICD-O-3 Cancer Classification Codes. These data are not available at the national level.

UF Health Cancer Center Catchment Area Profile

52

Table 9: Top Ten Cancer Incidence by Race and Ethnicity INCIDENCE (WHITE) RANK

CANCER SITE OR TYPE

CArea

FL

US

All Sites

518.7

506.3

451.0

1

Breast

125.2

123.9

126.9

2

Prostate

88.3

91.1

95.8

3

Lung

73.8

62.8

59.3

4

Colorectal

40.6

39.7

37.7

5

Hematologic/Blood

40.5

42.0

—

6

Melanoma

29.1

28.6

25.6

7

Uterine

25.7

25.4

26.4

8

Bladder

21.1

20.8

21.3

9

Kidney

17.1

15.4

17.0

10

Oropharyngeal

17.0

15.6

12.9

CArea

FL

US

All Sites

454.0

461.1

447.6

1

Prostate

168.2

170.7

167.8

I NCI DENCE (BL ACK) RANK

CANCER SITE OR TYPE

2

Breast

113.8

118.7

124.4

3

Lung

56.0

48.6

59.4

4

Colorectal

46.1

46.6

43.7

5

Hematologic/Blood

41.6

43.3

—

6

Uterine

30.7

31.5

25.1

7

Kidney

17.0

15.1

18.4

8

Pancreatic

16.2

15.4

15.7

9

Oropharyngeal

10.6

9.7

9.4

10

Ovarian

9.0

9.9

8.8

CArea

FL

US

I N C I D E N C E ( H I S PA N I C ) RANK

CANCER SITE OR TYPE

338.3

370.0

344.8

1

All Sites Breast

94.3

95.1

94.2

2

Prostate

86.3

95.4

84.7

3

Hematologic/Blood

35.5

37.5

—

4

Colorectal

32.8

37.5

33.7

5

Lung

32.2

36.3

29.5

6

Uterine

22.4

22.3

22.6

7

Kidney

13.3

12.7

16.6

8

Bladder

11.9

12.4

10.7

9

Ovarian

11.6

9.6

10.0

10

Liver

9.9

8.3

13.5

Data Source: For U.S. Incidence: CDC, 2013-2017, United States Cancer Statistics; For FL and catchment area incidence: FCDS, 2013-2017 Average Annual Age-Adjusted Cancer Incidence per 100,000 Population Note: 1) Blood cancers are comprised from Leukemia, Hodgkin’s Lymphoma, Non-Hodgkin’s Lymphoma, and Myeloma based on CDC SEER ICD-O-3 Cancer Classification Codes. These data are not available at the national level.

53

UF Health Cancer Center Catchment Area Profile

COMPARISONS BY GEOGRAPHIC DESIGNATIONS: RURAL/NON-RURAL AND LOW/HIGH SEV Among top cancers, breast, melanoma, and bladder cancers showed higher incidence in non-rural and low vulnerable areas compared to other areas in the catchment.

Figure 31: Top Ten Cancer Incidence by UFHCC Catchment Area Geographic Designations

Data Source: Average Annual Age-Adjusted Cancer Incidence per 100,000 Population, FCDS, 2013-2017 Note: 1) Blood cancers are comprised from Leukemia, Hodgkin’s Lymphoma, Non-Hodgkin’s Lymphoma, and Myeloma based on CDC SEER ICD-O-3 Cancer Classification Codes. These data are not available at the national level.

UF Health Cancer Center Catchment Area Profile

54

Table 10: Top Ten Cancer Incidence by UFHCC Catchment Area Geographic Designations

RANK

1

CArea

RURAL

NON-RURAL

CANCER SITE OR TYPE INCIDENCE

CANCER SITE OR TYPE INCIDENCE

CANCER SITE OR TYPE INCIDENCE

All Sites 509.9

All Sites 492.0

All Sites 513.8

Breast 122.9

Breast 109.6

Breast 126.3

2

Prostate 96.0

Prostate 89.1

Prostate 98.0

3

Lung 71.2

Lung 85.2

Lung 67.2

5

Colorectal 40.6

Colorectal 42.9

Hematologic/Blood 41.3

4

Hematologic/Blood 40.5

Hematologic/Blood 37.3

Colorectal 39.9

7

Melanoma 26.6

Uterine 24.1

Melanoma 27.9

6

Uterine 25.7

Melanoma 21.1

Uterine 26.1

8

Bladder 19.5

Oropharyngeal 18.3

Bladder 20.4

9

Kidney 16.9

Kidney 17.9

Kidney 16.7

10

Oropharyngeal 16.0

Bladder 15.7

Oropharyngeal 15.3

RANK

1

CArea

HIGH SEV

LOW SEV

CANCER SITE OR TYPE INCIDENCE

CANCER SITE OR TYPE INCIDENCE

CANCER SITE OR TYPE INCIDENCE

All Sites 509.9

All Sites 520.8

Breast 122.9

Breast 117.3

All Sites 492.7 Breast 125.4

2

Prostate 96.0

Prostate 96.9

Prostate 93.5

3

Lung 71.2

Lung 85.5

Lung 61.4

5

Colorectal 40.6

Colorectal 45.8

Hematologic/Blood 39.9

4

Hematologic/Blood 40.5

Hematologic/Blood 40.4

Colorectal 36.9

7

Melanoma 26.6

Uterine 26.4

Melanoma 28.1

6

Uterine 25.7

Melanoma 21.3

Uterine 23.1

8

Bladder 19.5

Bladder 19.1

Bladder 19.5

9

Kidney 16.9

Oropharyngeal 18.5

Kidney 15.7

10

Oropharyngeal 16.0

Kidney 18.4

Oropharyngeal 14.2

Data Source: Average Annual Age-Adjusted Cancer Incidence per 100,000 Population, FCDS, 2013-2017 Note: 1) Blood cancers are comprised from Leukemia, Hodgkin’s Lymphoma, Non-Hodgkin’s Lymphoma, and Myeloma based on CDC SEER ICD-O-3 Cancer Classification Codes. These data are not available at the national level.

55

UF Health Cancer Center Catchment Area Profile

5

Site-specific Analysis of Advanced Stage Incidence

COMPARISONS BY GENDER, RACE, AND ETHNICITY Table 11: Top Ten Advanced Stage Cancer Incidence by Gender A D VA N C E D I N C I D E N C E ( F E M A L E ) RANK

CANCER SITE OR TYPE

CArea

FL

All Sites

200.8

192.2

1

Lung

41.5

35.6

2

Breast

41.4

42.1

3

Hematologic/Blood

26.2

26.8

4

Colorectal

20.1

19.0

5

Pancreatic

8.7

8.6

6

Ovarian

8.6

8.2

7

Uterine

7.9

7.8

8

Cervical

5.0

4.6

9

Thyroid

4.0

5.2

10

Oropharyngeal

3.7

3.7

CANCER SITE OR TYPE

CArea

FL

All Sites

240.2

221.0

A D VA N C E D I N C I D E N C E ( M A L E ) RANK

1

Lung

58.9

48.8

2

Hematologic/Blood

40.2

40.9

3

Colorectal

25.2

25.0

4

Prostate

18.5

18.5

5

Oropharyngeal

17.7

15.0

6

Pancreatic

12.9

11.8

7

Kidney

6.8

6.1

8

Liver

6.2

5.5

9

Melanoma

5.6

4.9

10

Bladder

4.1

3.8

Data Source: Average Annual Age-Adjusted Cancer Incidence per 100,000 Population, FCDS, 2013-2017; Advanced stage diagnosis incidence data not available for the U.S. Note: 1) Blood cancers are comprised from Leukemia, Hodgkin’s Lymphoma, Non-Hodgkin’s Lymphoma, and Myeloma based on CDC SEER ICD-O-3 Cancer Classification Codes. These data are not available at the national level.

•

Women in the UFHCC catchment area have higher advanced stage incidence rates for lung, colorectal, pancreatic, ovarian, uterine, and cervical cancers, compared to the state advanced stage incidence rates.

•

Men in the catchment area have advanced stage incidence rates higher than state levels for all cancers except blood and prostate cancers.

UF Health Cancer Center Catchment Area Profile

56

Table 12: Top Ten Advanced Stage Cancer Incidence by Race and Ethnicity A D VA N C E D I N C I D E N C E ( W H I T E ) RANK

CANCER SITE OR TYPE All Sites

CArea

FL

222.8

207.5

1

Lung

51.3

43.3

2

Breast

40.9

41.3

3

Hematologic/Blood

32.7

33.5

4

Colorectal

22.6

21.6

5

Prostate

17.2

17.2

6

Oropharyngeal

10.9

9.7

7

Pancreatic

10.7

10.1

8

Ovarian

9.2

8.6

9

Uterine

7.9

7.3

10

Cervical

5.3

4.6

CArea

FL

212.0

213.7

A D VA N C E D I N C I D E N C E ( B L A C K ) RANK

CANCER SITE OR TYPE All Sites

1

Breast

46.6

51.7

2

Lung

40.0

34.7

3

Hematologic/Blood

35.3

36.9

4

Prostate

30.1

31.0

5

Colorectal

25.7

26.4

6

Pancreatic

12.8

11.6

7

Uterine

10.5

12.9

8

Oropharyngeal

7.4

6.4

9

Ovarian

6.1

6.8

10

Cervical

5.0

6.4

CANCER SITE OR TYPE

CArea

FL

All Sites

A D VA N C E D I N C I D E N C E ( H I S P A N I C ) RANK

155.4

163.3

1

Breast

33.7

34.0

2

Hematologic/Blood

28.5

29.9

3

Lung

22.7

24.4

4

Colorectal

17.2

20.1

5

Prostate

15.6

18.3

6

Ovarian

9.1

6.8

7

Pancreatic

7.9

8.6

8

Uterine

7.2

6.6

9

Oropharyngeal

6.4

5.7

10

Cervical

5.1

4.5

Average Annual Age-Adjusted Cancer Incidence per 100,000 Population; For FL and catchment area incidence: FCDS, 2013-2017 Bolded italics indicate small numbers in raw counts (n<30) Note: 1) Blood cancers are comprised from Leukemia, Hodgkin’s Lymphoma, Non-Hodgkin’s Lymphoma, and Myeloma based on CDC SEER ICD-O-3 Cancer Classification Codes. These data are not available at the national level.

57

UF Health Cancer Center Catchment Area Profile

•

•

•

Advanced incidence in the catchment area’s white population is marked by rates higher than state rates for lung, colorectal, oropharyngeal, pancreatic, ovarian, uterine, and cervical cancers.

Advanced incidence in the catchment area’s Black population is marked by rates higher than state rates for lung, pancreatic, and oropharyngeal cancers.

The Hispanic population in the catchment area is small compared to the state and to the U.S., but it is growing. Advanced incidence rates for this group are characterized by higher rates of ovarian, uterine, oropharyngeal, and cervical cancer compared to state rates.

COMPARISONS BY GEOGRAPHIC DESIGNATIONS: RURAL/NON-RURAL AND LOW/HIGH SEV Figure 32: Top Ten Advanced Stage Cancer Incidence by UFHCC Catchment Area Geographic Designations

Data Source: Average Annual Age-Adjusted Cancer Incidence per 100,000 Population, FCDS, 2013-2017 Note: 1) Blood cancers are comprised from Leukemia, Hodgkin’s Lymphoma, Non-Hodgkin’s Lymphoma, and Myeloma based on CDC SEER ICD-O-3 Cancer Classification Codes. These data are not available at the national level.

•

Breast, pancreatic, and uterine cancers have higher advanced stage incidence rates in non-rural and high SEV areas compared to other areas of the catchment.

•

Among the top cancers, lung, colorectal, oropharyngeal and kidney cancers showed high advanced incidence in rural and high SEV areas.

UF Health Cancer Center Catchment Area Profile

58

Table 13: Top Ten Advanced Stage Cancer Incidence by UFHCC Catchment Area Geographic Designations

RANK

CArea

RURAL

NON-RURAL

CANCER SITE OR TYPE INCIDENCE

CANCER SITE OR TYPE INCIDENCE

CANCER SITE OR TYPE INCIDENCE

All Sites 218.4

All Sites 218.0

All Sites 217.9

1

Lung 49.5

Lung 57.5

Lung 47.1

2

Breast 41.4

Breast 36.4

Breast 42.7

3

Hematologic/Blood 32.8

Hematologic/Blood 29.6

Hematologic/Blood 33.5

5

Colorectal 22.5

Colorectal 24.7

Colorectal 21.8

4

Prostate 18.5

Prostate 15.2

Prostate 19.4

7

Pancreatic 10.7

Oropharyngeal 12.4

Pancreatic 10.9

6

Oropharyngeal 10.4

Pancreatic 9.7

Oropharyngeal 9.7

8

Ovarian 8.6

Ovarian 6.6

Ovarian 9.1

9

Uterine 7.9

Kidney 6.0

Uterine 8.5

10

Cervical 5.0

Uterine 5.9

Cervical 4.9

RANK

CArea

HIGH SEV

LOW SEV

CANCER SITE OR TYPE INCIDENCE

CANCER SITE OR TYPE INCIDENCE

CANCER SITE OR TYPE INCIDENCE

All Sites 218.4

All Sites 238.7

All Sites 203.3

1

Lung 49.5

Lung 60.1

Lung 42.3

2

Breast 41.4

Breast 42.7

Breast 40.7

3

Hematologic/Blood 32.8

Hematologic/Blood 32.7

Hematologic/Blood 32.4

5

Colorectal 22.5

Colorectal 25.4

Colorectal 20.6

4

Prostate 18.5

Prostate 18.1

Prostate 18.4

7

Pancreatic 10.7

Oropharyngeal 12.5

Pancreatic 10.4

6

Oropharyngeal 10.4

Pancreatic 11.0

Oropharyngeal 8.9

8

Ovarian 8.6

Uterine 8.7

Uterine 7.4

9

Uterine 7.9

Cervical 6.5

Kidney 4.6

10

Cervical 5.0

Kidney 5.4

Ovarian 4.4

Data Source: Average Annual Age-Adjusted Cancer Incidence per 100,000 Population, FCDS, 2013-2017 Note: 1) Blood cancers are comprised from Leukemia, Hodgkin’s Lymphoma, Non-Hodgkin’s Lymphoma, and Myeloma based on CDC SEER ICD-O-3 Cancer Classification Codes. These data are not available at the national level.

59

UF Health Cancer Center Catchment Area Profile

6

Site-specific Analysis of Mortality

COMPARISONS BY GENDER, RACE, AND ETHNICITY Table 14: Top Ten Cancer Mortality by Gender INCIDENCE (FEMALE) RANK CANCER SITE OR TYPE All Sites

CArea

FL

US

136.3

125.1

135.7

1

Lung

36.0

30.9

33.2

2

Breast

19.6

18.8

20.3

3

Colorectal

12.9

11.1

11.8

4

Hematologic/Blood

11.8

10.9

—

5

Pancreatic

8.9

9.0

9.6

6

Ovarian

6.5

6.2

6.9

7

Uterine

4.2

4.5

2.3

8

Brain

3.6

3.4

3.6

9

Liver

3.3

3.6

4.0

10

Cervical

2.9

2.6

2.3

CArea

FL

US

201.4

174.3

189.5

INCIDENCE (MALE) RANK CANCER SITE OR TYPE All Sites 1

Lung

56.1

45.2

49.3

2

Hematologic/Blood

19.9

18.4

—

3

Colorectal

17.6

15.5

16.6

4

Prostate

17.3

16.4

19.1

5

Pancreatic

13.0

12.2

12.7

6

Liver

9.4

9.3

9.6

7

Esophageal

8.7

6.2

7.0

8

Bladder

8.2

7.1

7.5

9

Brain

6.0

5.1

5.4

10

Kidney

5.6

4.9

5.4

Data Source: For U.S. Mortality: CDC, 2013-2017, United States Cancer Statistics; for FL and catchment area mortality: FDOH, 2014-2018, FLHealthCharts – Death Count Query System Note: 1) Average Annual Age-Adjusted Cancer Mortality per 100,000 Population. 2) Blood cancers are comprised from Leukemia, Hodgkin’s Lymphoma, Non-Hodgkin’s Lymphoma, and Myeloma based on CDC SEER ICD-O-3 Cancer Classification Codes. These data are not available at the national level.

•

Women in the UFHCC catchment area have higher mortality rates for lung, colorectal, blood and cervical cancers, compared to the state and national mortality rates.

•

Men in the catchment area have mortality rates higher than state and national levels for all cancers except prostate and liver cancers.

UF Health Cancer Center Catchment Area Profile

60

Table 15: Top Ten Cancer Mortality by Race and Ethnicity M O R TA L I T Y ( W H I T E ) RANK CANCER SITE OR TYPE All Sites

CArea

FL

US

168.6

147.8

159.0

1

Lung

47.4

38.9

41.0

2

Breast

19.2

18.3

19.8

3

Prostate

15.9

15.0

17.9

4

Hematologic/Blood

15.6

14.2

—

5

Colorectal

14.9

12.9

13.6

6

Pancreatic

10.8

10.4

10.9

7

Ovarian

6.9

6.4

7.1

8

Liver

6.2

6.1

6.2

9

Brain

5.3

4.5

4.8

10

Bladder

5.2

4.5

4.6

•

Mortality in the catchment area’s white population is marked by rates higher than state and national rates for lung, blood, colorectal, brain, and bladder cancers.

•

Mortality in the catchment area’s Black population is marked by rates higher than state rates for blood cancers.

•

The Hispanic population in the catchment area is small compared to the state and to the U.S. but it is growing.

Mortality rates for this group are characterized by higher rates of blood, pancreatic and brain cancers compared to state and national rates.

•

Note that comparisons across race demonstrate higher rates of mortality within the Black population for prostate, breast, colorectal, blood, pancreatic, uterine, liver, and cervical cancers compared to the white population.

M O R TA L I T Y ( B L A C K ) RANK CANCER SITE OR TYPE

CArea

FL

US

All Sites

164.2

150.3

181.7

1

Prostate

35.1

33.6

37.9

2

Lung

32.5

29.1

42.3

3

Breast

25.2

24.1

27.6

4

Colorectal

18.4

15.9

18.5

5

Hematologic/Blood

16.4

15.1

—

6

Pancreatic

12.2

11.1

13.3

7

Uterine

8.3

8.4

3.6

8

Liver

6.6

7.1

8.4

9

Ovarian

4.9

5.3

6.0

10

Cervical

3.6

3.8

3.4

CArea

FL

US

103.0

111.7

112.3

M O R TA L I T Y ( H I S P A N I C ) RANK CANCER SITE OR TYPE All Sites 1

Lung

15.1

20.8

17.6

2

Hematologic/Blood

14.8

12.8

—

3

Prostate

13.1

16.7

15.8

4

Breast

10.9

14.5

14.0

5

Colorectal

10.5

11.7

11.1

6

Pancreatic

9.4

8.9

8.5

7

Liver

6.2

6.4

9.3

8

Ovarian

4.5

4.7

5.2

9

Brain

4.1

3.5

3.0

10

Uterine

3.7

4.1

1.6

Data Source: Average Annual Age-Adjusted Cancer Mortality per 100,000 Population, For U.S. Mortality: CDC, 2013-2017, United States Cancer Statistics. For FL and catchment area mortality: FDOH, 2014-2018, FLHealthCharts – Death Count Query System Bolded italics indicate small numbers in raw counts (n<30) Note: 1) Blood cancers are comprised from Leukemia, Hodgkin’s Lymphoma, Non-Hodgkin’s Lymphoma, and Myeloma based on CDC SEER ICD-O-3 Cancer Classification Codes. These data are not available at the national level.

61

UF Health Cancer Center Catchment Area Profile

COMPARISONS BY GEOGRAPHIC DESIGNATIONS: RURAL/NON-RURAL* There are no cancers that have higher mortality rates in non-rural areas compared to rural areas.

Rural mortality rates exceed those of non-rural areas of the catchment for all cancers shown below.

Table 16: Top Ten Cancer Mortality by UFHCC Catchment Area Geographical Designations RURAL

NON-RURAL

CANCER SITE OR TYPE INCIDENCE

CANCER SITE OR TYPE INCIDENCE

1

Lung 60.8

Lung 41.3

2

Breast 21.4

Breast 19.5

3

Prostate 20.3

Prostate 16.6

4

Colorectal 18.2

Hematologic/Blood 15.2

5

Hematologic/Blood 16.9

Colorectal 14.2

6

Pancreatic 11.1

Pancreatic 10.8

7

Liver 7.8

Ovarian 6.5

8

Ovarian 6.6

Liver 5.7

9

Bladder 5.8

Esophageal 4.9

10

Esophageal 5.0

Bladder 4.7

Data Source: Average Annual Age-Adjusted Cancer Mortality per 100,000 Population, FDOH, 2014-2018, FLHealthCharts – Death Count Query System Note: 1) Blood cancers are comprised from Leukemia, Hodgkin’s Lymphoma, Non-Hodgkin’s Lymphoma, and Myeloma based on CDC SEER ICD-O-3 Cancer Classification Codes. These data are not available at the national level.

Figure 33: Top Ten Advanced Stage Cancer Mortality by UFHCC Catchment Area Geographic Designations

Lung

Breast

Prostate

Colorectal Hematologic/ Pancreatic Blood

Liver

Ovarian

Bladder

Esophageal

Data Source: Average Annual Age-Adjusted Cancer Mortality per 100,000 Population, FDOH, 2014-2018, FLHealthCharts – Death Count Query System Note: 1) Blood cancers are comprised from Leukemia, Hodgkin’s Lymphoma, Non-Hodgkin’s Lymphoma, and Myeloma based on CDC SEER ICD-O-3 Cancer Classification Codes. These data are not available at the national level.

UF Health Cancer Center Catchment Area Profile

62

63

UF Health Cancer Center Catchment Area Profile

4 CO - OCCUR R I NG CON DITION S

UF Health Cancer Center Catchment Area Profile

64

1

Co-occurring Conditions and Cancer Diagnosis

IN THIS SECTION

we focus on identifying the co-occurring conditions* that individuals have both

prior to and after the first occurrence of a cancer diagnosis.** These analyses stem from an understanding that:

1. Approximately 60% of all adults in the U.S. had at least one and 42% had more than one chronic condition.

2. According to the National Cancer Institute, aging-relevant factors, including the presence of co-occurring conditions, need to be better understood related to the impact on cancer burden.

3. The effects of co-occurring conditions on cancer burden are not confined to older adults. One study of medical records of adolescents that focused on the co-occurrence of behavioral health disorders reported that almost 30% of males and almost 50% of females with substance use disorder had a dual diagnosis with a mood disorder, with lower rates for anxiety disorders (9% male and 19% female) (17).

The following example highlights the co-occurring conditions as they relate to a lung cancer diagnosis.

For data related to additional cancers, visit the PORTRAIT data tool online.

Using OneFlorida Electronic Health Records (EHR) and claims data, including Florida Medicaid and Medicare, we identified patients within the UFHCC catchment area counties who had co-occurring physical and behavioral health conditions that were present: a. At least one year prior to first appearance of the cancer diagnosis in the data source.*** b. During the year in which the cancer diagnosis was observed or later.****

LUNG CANCER PATIENTS’ CONDITIONS PRE-CANCER DIAGNOSIS AND POST-DIAGNOSIS

65

PRE- LUNG CANCER DIAGNOSIS

POST- LUNG CANCER DIAGNOSIS

~18% had behavioral and physical health conditions up to one year before diagnosis

~30% had behavioral and physical health conditions co-occurring or following diagnosis

Tobacco use, abuse, and dependence was the most common behavioral health condition listed prior to a cancer diagnosis, at 11.4%.

Tobacco use, abuse, and dependence was the most common behavioral health condition listed after a cancer diagnosis, at 18.6%.

Other common behavioral health conditions pre-cancer diagnosis were depression (9%), followed by anxiety (8.5%).

Other common behavioral health conditions post-cancer diagnosis were anxiety (~17%), followed by depression (15%).

Physical health conditions: Patients who were diagnosed with lung cancer had relatively high rates of hypertension (37.3%) and COPD (8.4%) compared to the general population in Florida according to Florida Health Charts (33.5% and 7.7%, respectively) (18).

Physical health conditions: Patients who were diagnosed with lung cancer had relatively lower rates of hypertension (29%), but higher rates of COPD (~34%) compared to the general population in Florida according to Florida Health Charts (33.5% and 7.7%, respectively) (18).

UF Health Cancer Center Catchment Area Profile

Figure 34: NCI Comorbidity Indices, Pre- and Post- Cancer Diagnosis

PRE-DIAGNOSIS WEIGHTED INDEX MEAN: 2.2

The NCI Comorbidity Index is a cancer-specific weighted index developed to predict risk of mortality for patients with specific comorbid conditions. 14 conditions were included in the index with higher scores indicating greater risk of death. All diagnosis and procedure codes were assessed in the year prior to the cancer diagnosis date for the pre-existing profile and in the year following the cancer diagnosis date for the post and concurrently-existing profile.

The NCI Comorbidity Index is similar to the

POST-DIAGNOSIS WEIGHTED INDEX MEAN: 2.5

Charlson Comorbidity Index that categorizes patient co-occurring conditions based on the International Classification of Diseases (ICD) codes that physicians use. For the Charlson Comorbidity Index, a weighted score is assigned to patients, with the lowest score of zero indicating that no comorbidities were found. Higher Charlson Comorbidity Index scores indicate a higher likelihood of mortality and/or health care utilization (19).

* Co-occurring conditions were identified from non-ancillary encounters by a diagnosis at one inpatient encounter or two outpatient E&M encounters within two years. Cancer patients identified as having more than one co-occurring condition are included in each of the relevant condition counts. ** Cancer patients were identified from non-ancillary encounters occurring Jan. 1, 2014 to Dec. 31, 2018 as patients having a diagnosis at one inpatient encounter or two outpatient E&M encounters within two years. Cancer diagnoses were counted once per day to avoid overcounting.

The cancer diagnosis date, defined as the earliest date of the first non-ancillary inpatient diagnosis or the first of two non-ancillary outpatient diagnoses within two years was used to define age and determine if conditions were prior to or after diagnosis. *** Pre-existing conditions are those co-occurring conditions identified from Jan. 1, 2012 to one year prior to the cancer diagnosis. **** Post-diagnosis conditions are those co-occurring conditions identified from one year prior to the cancer diagnosis to Dec. 31, 2019.

Patients with a specific pre-existing condition were not included in post-diagnosis counts for that same condition.

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UF Health Cancer Center Catchment Area Profile

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C A NC ER R I SK FACTORS

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1

Risk Factors in the UFHCC Catchment Area: Tobacco & Cancer Screening Rates

SPECIAL FOCUS: TOBACCO IN THE CATCHMENT AREA Tobacco products include cigarette, cigars or smokeless tobacco, as well as e-cigarettes and vaping products. While cigarette smoking continues to decline in Florida, rates in the UFHCC catchment area remain some of the highest in the state. In 2017, the overall rate of current cigarette smokers age 16 and older in Florida was

down to 16%. However, in the UFHCC catchment area, rates were as high as 25%, with 14 of the 23 counties having current smoking rates over 20%.

The trend remains the same for current cigarette/ e-cigarette smoker rates, with the UFHCC catchment area seeing some of the highest rates of usage for those age 16 and older.

Figure 35: Adult Smoking Rate in the UFHCC Catchment Area

=

=

Florida Rate (16%)

Data Source: County Health Rankings and Roadmaps, 2020, 2020 County Health Ranking National Data

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UF Health Cancer Center Catchment Area Profile

Figure 36: Adult Smoking Rate in the state of Florida

•

•

All 16 rural counties in catchment area and most non-rural counties had relatively high adult smoking rates in 2017, compared to the state average of 16%.

= 12.2 - 16.4 = 16.5 - 18.7 = 18.8 - 19.9

Among non-rural counties in catchment area, only Sumter County’s adult smoking rate is lower than Florida’s state rate.

= 20.0 - 22.4 = 22.5 - 24.7

Data Source: County Health Rankings and Roadmaps, 2020, 2020 County Health Ranking National Data

YOUTH SMOKING AND TOBACCO PRODUCT USE Figure 37: Percent of Youth Who Have Ever Tried Tobacco Products in the UFHCC Catchment Area

=

=

Florida Rate (18.2%)

Data Source: FDOH, 2018, FLHealthCharts – Florida Youth Tobacco Survey Data No survey data available for Columbia, Leon and Taylor counties

• •

Among catchment area counties, there are no survey data for Columbia, Leon and Taylor counties In Jefferson, Alachua, Lake and Clay counties youth had lower tobacco use rates in 2018 compared to the state rate of 18.2%

•

Rural counties in catchment demonstrate higher youth tobacco use rates compared to non-rural counties, and compared to the state of Florida

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YOUTH VAPING Survey data from all middle and high school students indicate that the percent of students who have ever used an electronic vapor product is higher in rural areas than in non-rural areas of our catchment.

However, the majority of the counties with data available have youth vaping rates higher than the state average of 28%.

Figure 38: Percent of Youth Who Have Ever Used Vapor Products in the UFHCC Catchment Area

=

=

Florida Rate (27.9%)

Data Source: FDOH, 2018, FLHealthCharts – Florida Youth Tobacco Survey Data No survey data available for Columbia, Leon and Taylor counties

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UF Health Cancer Center Catchment Area Profile

SPECIAL FOCUS: SCREENING RATES IN THE UFHCC CATCHMENT AREA As described above, there are four cancers that have evidence-based, effective screenings for cancer, according to the NCI and the USPSTF: lung, breast, colorectal, and cervical cancers. In this section, we present brief statistics about common cancer screenings in the catchment area: mammograms, the Pap test, and a blood stool test.

Mammograms Among women aged 50 to 74 who had a mammogram in the past 2 years, we see that higher screening rates are evident in non-rural areas compared to rural areas.

Only eight counties have mammogram rates above the state level of 61%.

• •

Figure 39: Women Age 40 + Who Had a Mammography in the Past Year in the UFHCC Catchment Area

=

=

Florida Rate (60.8%)

Data source: FDOH, 2018, FLHealthCharts – Florida Youth Tobacco Survey Data

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CERVICAL CANCER SCREENING – THE PAP TEST

•

Survey data demonstrate that among women 21 - 65 who received a Pap test in the past three years, only six counties have a screening rate that exceeds the state average of 79%.

•

Seventeen of the 23 counties in the catchment area fall below the state average for Pap tests in the past three years.

Figure 40: Women Age 21-65 Who Had a Pap Test in the Past Three Years in the UFHCC Catchment Area

=

=

Florida Rate (78.8%)

Data Source: FDOH, 2016, FLHealthCharts – Florida Behavioral Risk Factor Data

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UF Health Cancer Center Catchment Area Profile

BLOOD STOOL TESTS

•

This test is an important screening tool related to colorectal cancer, one of the top cancers in our catchment area for incidence, advanced stage incidence, and mortality.

•

Blood stool tests for individuals 50 years of age or older exceeded the state average of 36% in thirteen counties.

Figure 41: Adults Age 50+ Who Had Ever Had a Blood Stool Test in the UFHCC Catchment Area

=

=

Florida Rate (36.0%)

Data source: FDOH, 2016, FLHealthCharts – Florida Behavioral Risk Factor Data

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UF Health Cancer Center Catchment Area Profile

6 C ATC H M ENT AREA P R IOR IT Y C A NC ERS

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1

UFHCC Priority Cancers: Criteria Identification & Selection

W H I L E A L L C A N C E R S T H AT A F F E C T R E S I D E N T S

of our catchment area are a priority for the dedicated

teams of researchers and clinicians at the UF Health Cancer Center, we have identified six cancers of highest priority: lung, breast, leukemia, HPV-related head and neck cancer, HPV-related cervical, and brain. In this report, we focus on lung cancer as one of our priority cancers. A similar deep-dive for other cancers can be found within our online portal: PORTRAIT: Partnerships to Optimize and Transform Research through Action and Impact Together.

UFHCC Priority Cancers: 1.

2.

3.

4.

5.

6.

Lung Breast Leukemia HPV-related Head and Neck HPV-related Cervical Brain

NOTE: These focal cancers will be revised with ongoing data analyses

The six cancers chosen as priorities were selected based on one or more of the following criteria: Have a higher incidence rates in the UFHCC Catchment Area compared with Florida and the U.S.; Show evidence of disparities in outcomes; Institution has made an investment and developed Research Programs and/or specialized Centers of Excellence; Identified by the Community Advisory Board as a priority; Are a focus of ongoing Community Outreach and Engagement activities; Are scientifically supported through ongoing research across all three Research Programs.

• • • • • •

LUNG CANCER — PRIORITY CANCER OVERVIEW Figure 42: Lung Cancer Incidence in the State of Florida

Lung Cancer Incidence Male population has higher lung cancer incidence than female population in the catchment area.

The white population has higher incidence rates than the Black and Hispanic populations.

Catchment area has higher lung cancer incidence for women and men and both the white and Black populations compared to state rates.

• • •

= 30.6 - 58.6 = 58.7 - 67.2 = 67.3 - 72.2 = 72.3 - 80.9 = 81.0 - 101.7

Data Source: Annual Average Age-adjusted Lung Cancer Incidence per 100,000 population, FCDS 2013-2017 Union County (212.4) is an outlier due to state prison cancer center Annual Average Age-adjusted Lung Cancer Incidence per 100,000 population, FCDS 2013-2017

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UF Health Cancer Center Catchment Area Profile

Table 17: Lung Cancer Incidence Rates by Race, Ethnicity, and Gender LUNG CANCER INCIDENCE (ALL GENDERS)

CArea

CArea

LOW SEV

HIGH SEV

ALL RACES

WHITE

BLACK

HISPANIC

FL

60.2

62.8

48.6

36.3

CA

71.2

73.8

56.0

32.2

Non-Rural

67.2

69.8

52.0

32.4

Rural

85.2

89.1

64.5

31.4

Low SEV

61.4

63.4

44.3

27.5

High SEV

85.5

90.6

64.1

39.8

Non-Rural

58.9

60.9

41.8

28.1

Rural

80.7

83.7

57.7

Non-Rural

83.5

88.7

62.0

43.7

Rural

88.8

93.8

67.0

31.9

ALL RACES

WHITE

BLACK

HISPANIC

FL

52.8

56.2

36.9

26.1

CArea

60.7

64.6

38.8

25.3

Non-Rural

58.7

62.1

39.0

25.5

Rural

68.2

74.9

38.8

Low SEV

54.6

57.3

32.9

22.4

High SEV

69.7

76.6

43.2

31.0

Non-Rural

52.2

54.8

31.8

23.3

Rural

74.6

79.1

39.9

Non-Rural

71.1

77.7

46.0

Rural

67.0

74.7

39.9

ALL RACES

WHITE

BLACK

HISPANIC

FL

69.2

70.9

64.7

50.5

CArea

83.6

84.6

78.8

40.3

Non-Rural

77.5

79.0

69.8

40.8

104.5

105.2

98.6

36.5

Low SEV

69.5

70.8

58.3

33.6

High SEV

104.2

106.7

92.8

48.9

Non-Rural

66.9

68.3

54.9

33.9

Rural

88.2

89.3

80.4

Non-Rural

98.4

101.8

84.6

Rural

113.3

115.0

105.2

LUNG CANCER INCIDENCE (FEMALES)

CArea

CArea

LOW SEV

HIGH SEV

LUNG CANCER INCIDENCE (MALES)

CArea

CArea

LOW SEV

HIGH SEV

Rural

33.3

55.4

Data Source: Average annual age-adjusted incidence, per 100,000 population, FCDS 2013-2017 Note: Bolded italics indicate small numbers in raw counts (n<30); Blank cells indicate small numbers in raw counts (n<16)

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Figure 43: Lung Cancer Incidence by UFHCC Catchment Area Geographic Designations

Data Source: Average annual age-adjusted incidence, per 100,000 population, FCDS 2013-2017

• •

Lung cancer incidence is higher in high SEV areas compared to low SEV areas. However, the highest rates for women are found in low SEV and rural areas, where burden is compounded by this intersection.

Men in rural and high SEV areas have the highest lung cancer incidence among any of the demographic and geographic breakdowns.

Site-specific: Advanced Stage Lung Cancer The catchment area has higher advanced stage lung cancer incidence than Florida The catchment area’s rural counties and high SEV areas have higher rates of advanced stage lung cancer incidence than the catchment area’s non-rural counties and low SEV areas, respectively.

• •

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UF Health Cancer Center Catchment Area Profile

Table 18: Lung Cancer Advanced Stage Incidence Rates by Race, Ethnicity, and Gender LUNG CANCER ADVANCED INCIDENCE (ALL GENDERS)

CArea

CArea

LOW SEV

HIGH SEV

ALL RACES

WHITE

BLACK

HISPANIC

FL

41.6

43.3

34.7

24.4

CA

49.5

51.3

40.0

22.7

Non-Rural

47.1

49.0

36.6

22.3

Rural

57.5

59.7

47.0

25.2

Low SEV

42.3

43.6

31.7

20.2

High SEV

60.1

63.8

45.8

26.6

Non-Rural

41.0

42.4

28.9

20.3

Rural

52.1

53.0

45.5

Non-Rural

59.4

63.4

44.0

28.2

Rural

61.1

64.3

48.3

23.1

ALL RACES

WHITE

BLACK

HISPANIC

FL

35.6

37.9

25.0

16.9

CArea

41.5

44.3

26.2

16.2

Non-Rural

40.0

42.5

25.0

15.7

Rural

47.1

51.5

29.0

Low SEV

36.7

38.5

22.3

15.2

High SEV

48.9

54.2

29.2

17.9

Non-Rural

35.1

37.0

19.8

15.5

Rural

49.2

51.5

35.1

Non-Rural

49.9

55.2

29.7

Rural

46.9

52.2

28.7

ALL RACES

WHITE

BLACK

HISPANIC

FL

48.8

49.8

47.8

34.6

CArea

58.9

59.5

57.5

30.4

Non-Rural

55.5

56.6

52.2

30.3

Rural

69.0

68.6

69.8

30.1

Low SEV

48.9

49.6

43.0

26.1

High SEV

73.2

74.8

67.8

35.4

Non-Rural

47.8

48.7

40.5

25.9

Rural

55.6

54.9

59.0

Non-Rural

70.8

73.1

63.8

Rural

76.4

77.2

74.3

LUNG CANCER ADVANCED INCIDENCE (FEMALES)

CArea

CArea

LOW SEV

HIGH SEV

LUNG CANCER ADVANCED INCIDENCE (MALES)

CArea

CArea

LOW SEV

HIGH SEV

17.8

39.1

Data Source: Average annual age-adjusted incidence, per 100,000 population, FCDS 2013-2017 Bolded italics indicate small numbers in raw counts (n<30); Blank cells indicate small numbers in raw counts (n<16)

UF Health Cancer Center Catchment Area Profile

80

Figure 44: Lung Cancer Advanced Stage Incidence by UFHCC Catchment Area Geographic Designations

Data Source: Average annual age-adjusted advanced stage incidence, per 100,000 population, FCDS 2013-2017

• •

81

Advanced stage lung cancer incidence is higher in high SEV areas compared to low SEV areas.

However, the highest rates for women are found in high SEV and non-rural areas.

For men in the UFHCC catchment area, advanced stage lung cancer incidence rates are the highest in high SEV areas, both in rural and non-rural contexts. Rural men in high SEV areas bear the biggest burden for advanced stage lung cancer diagnoses.

UF Health Cancer Center Catchment Area Profile

Site-specific Mortality: Lung Cancer The UFHCC catchment area has higher lung cancer mortality compared to the state of Florida, a pattern that is also seen within the white and the Black population.

Within the catchment area, mortality rates from lung cancer are higher in rural counties across all demographic groups, compared to rates in non-rural counties.

• •

Table 19: Lung Cancer Mortality Rates by Race, Ethnicity, and Gender

LUNG CANCER MORTALITY (ALL GENDERS)

ALL RACES

WHITE

BLACK

HISPANIC

FL

37.4

38.9

29.1

20.8

CArea

45.3

47.4

32.5

15.1

Non-Rural

41.3

43.2

28.5

14.6

Rural

60.8

64.8

41.3

18.8

ALL RACES

WHITE

BLACK

HISPANIC

FL

30.9

32.7

20.6

13.6

CArea

36.0

38.3

21.3

11.2

Non-Rural

33.5

35.4

20.3

11.1

Rural

45.9

50.6

24.0

ALL RACES

WHITE

BLACK

HISPANIC

FL

45.2

46.2

40.7

31.0

CArea

56.1

57.8

47.7

19.3

Non-Rural

50.4

52.1

39.7

18.4

77.6

80.6

64.1

CArea

LUNG CANCER MORTALITY (FEMALES)

CArea

LUNG CANCER MORTALITY (MALES)

CArea Rural

Data Source: Average annual age-adjusted mortality, per 100,000 population, FDOH, 2014-2018, FLHealthCharts – Death Count Query System Note: Bolded italics indicate small numbers in raw counts (n<30); Blank cells indicate small numbers in raw counts (n<16)

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82

Figure 45: Lung Cancer Mortality Rates by UFHCC Catchment Area Geographic Designations

Data Source: Annual average annual age-adjusted mortality, per 100,000 population, FDOH, 2014-2018, FLHealthCharts – Death Count Query System

Lung Cancer Research across Basic, Clinical, and Population Science Programs To address the cancer burden related to tobacco use and lung cancer, UFHCC members from all three research programs, Cancer Control and Population Sciences (CCPS), Cancer Therapeutics & Host Response (CTHR), and Mechanisms of Oncogenesis (MOO), study nicotine addiction, develop novel therapies for small cell lung cancer and implement tobacco cessation strategies. While most of these were existing research programs, the UF Health Cancer Center recently identified a gap in tobacco product use prevention research, particularly among adolescents, when habits related to long-term tobacco are formed. In response to this identified need, cancer center leadership worked with Ramzi Salloum, PhD. (CCPS) to facilitate access to a range of UF Health inpatient, primary care, and oncology settings to test tobacco control strategies.

CANCER CONTROL & POPULATION SCIENCES (CCPS) Ramzi Salloum, PhD, successfully tested implementation strategies to promote the uptake of evidence-based tobacco control recommendations in various clinical settings. This work led to a partnership with CVS and their “Be the First Tobacco-Free Generation” initiative. The project will provide tobacco education to rural youth through schools and rural county extension offices’ youth-development programs.

CANCER THERAPEUTICS & HOST RESPONSE (CTHR) Chengguo Xing, PhD., is examining the use of dihydromethyusticin (DHM or Kava) for lung cancer chemoprevention among individuals; specifically, to elucidate the mechanisms through which DHM prevents tobacco carcinogen-induced lung tumorigenesis. The long-term goal is to generate experimental evidence to support clinical translation of this natural product to human lung cancer prevention.

MECHANISMS OF ONCOGENESIS (MOO) Frederic Kaye, MD is conducting research on the first-of-its-kind intralesional delivery of oncolytic virotherapy for limited-stage small cell lung cancer (SCLC) (Florida Biomedical Research Program, FBRP 8JK04).

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UF Health Cancer Center Catchment Area Profile

LUNG CANCER RISK FACTORS AND COMMUNITY-BASED PROGRAMS Several community efforts from our growing network of partners are also addressing tobacco burden and aiming to increase cancer screening rates in our catchment area and beyond. Our partners doing tobacco cessation treatment services and leading recent policy change are assets to the UFHCC and the communities it aims to serve.

Tobaco Free Alachua: Tobacco 21 Tobacco Free Alachua is a community-based partnership tasked with developing and promoting policies and programs that reduce the use and effects of tobacco in Alachua County. (20) “Tobacco 21,” a county-wide policy that raises the age of tobacco sales from 18 to 21 and creates a 1000-foot buffer for sales around schools, was passed by the Alachua County Board of County Commissioners in January 2019. Local policy change was enacted in Alachua County with direct support from the COE office. Alachua was the first Florida county to implement Tobacco 21 and COE is sharing information with Volusia, Sarasota, and Hillsborough counties outside of its catchment area, to assist them in enacting policy change.

COE leadership, and UF faculty and staff went on Area Health Education Centers (AHEC) Program The Area Health Education Centers (AHEC) Program offices and centers work extensively with health care systems to integrate strategies that ensure tobacco use is assessed and treated at every encounter. They educate and prepare current and future health care professionals to address tobacco use with patients using evidence-based methods and provide free intensive tobacco treatment services for Florida residents by offering group tobacco cessation classes and nicotine replacement products, such as patches, lozenges and gum. Gulfcoast North AHEC, Central Florida AHEC and the UF AHEC Program along with three of its affiliated non-profit centers – Big Bend AHEC in Tallahassee, Northeast Florida AHEC in Jacksonville, and Suwannee River AHEC in Alachua – provide tobacco training, cessation and systems change activities throughout the UF Health Cancer

Figure 46: The Updated Tobacco 21 Map Highlighting Florida’s New Policy Status

record to present UFHCC’s data on the catchment area’s tobacco use and lung cancer burden in support of Tobacco Free Alachua, a community partner.

Figure 47: Percent Tobacco-Related Cancer Death over All Cancer Death, with AHEC Tobacco Cessation Locations Data source: FDOH, 2015-2019, FLHealthCharts – Chronic Diseases (! (!

(! (! (! (!(!(!(!((!!(!(!((!!

(!(!

(!

(!(!

(!

(! (! (!

(!(!(! (!(!(!

(! (!(! (!(!(!

(!

(!

(!(!

(! (!

(! (!

((!!

(!

(!(!(!

(! (!(! (!

(!

= 45.2 - 46.7

(!

(!

(!(!(! ((!!(!(! (! (!

(!

(!(!

(!(! (!

(!

(! (!

(! (! (!

(!

(! (!

(! (!

(!

(!

(! (!(!(!

= 40.1 - 45.1

(!

(!

(! (!!(!(!(!(!(!(! (!(!( (!(!(!(!(! (!

(!

(!(!

(!

(! (!

= 46.8 - 49.2 = 49.3 - 50.2 = 50.3 - 58.4 = Area Health Education Center (AHEC) Tobacco Cessation Locations, 2018

Center’s 23-county catchment area. Over 1,700 participants in the UFHCC catchment area attended an AHEC group session in 2018.

UF Health Cancer Center Catchment Area Profile

84

85

Image provided by Gainesville Community Redevelopment Association

UF Health Cancer Center Catchment Area Profile

7

R EF ER ENC ES A N D DATA S OURC ES

UF Health Cancer Center Catchment Area Profile

86

1

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UF Health Cancer Center Catchment Area Profile

12. Social Determinants of Health. (n.d.). Retrieved January 29, 2021, from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

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14. Brenes F. (2019). Hispanics, Mental Health, and Discriminating Policies: Brief Report. Hispanic health care international: the official journal of the National Association of Hispanic Nurses, 17(4), 178–180. https://doi.org/10.1177/1540415319875103

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17. Wu, L. T., Gersing, K., Burchett, B., Woody, G. E., & Blazer, D. G. (2011). Substance use disorders and comorbid Axis I and II psychiatric disorders among young psychiatric patients: findings from a large electronic health records database. Journal of psychiatric research, 45(11), 1453-1462.

18. Florida Health Charts. (2019). Behavioral Risk Factor Surveillance System telephone survey conducted by the Centers for Disease Control and Prevention (CDC) and Florida Department of Health Division of Community Health Promotion. Retrieved January 29, 2021 from http://www.flhealthcharts.com/charts/Brfss/StateDataViewer.aspx?bid=8

19. Stedman MR, Doria-Rose P, Warren JL, Klabunde CN, Mariotto A. The Impact of Different SEER-Medicare Claims-based Comorbidity Indexes on Predicting Non-cancer Mortality for Cancer Patients. NCI Comorbidity Technical Report. 2019. Retrieved January 29, 2021, from https://healthcaredelivery.cancer.gov/seermedicare/considerations/comorbidity-report.html

20. Hutchinson, D. (2020, February 07). Alachua. Retrieved January 29, 2021, from https://tobaccofreeflorida.com/county/alachua/

2

• • •

Data Sources

OneFlorida U.S. Census Bureau: Census Data Centers for Disease Control and Prevention: U.S. Cancer Statistics; Behavioral Risk Factor Surveillance System (BRFSS); National Immunization Survey

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Florida Department of Health: Florida Cancer Data System (FCDS); Florida Health Charts UF Health Cancer Center Tumor Registry Data

UF Health Cancer Center Catchment Area Profile

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352-2 7 3- 80 10

C A NCER . UFL . ED U

C A NC ER- C ENTER@UF L . ED U

2033 Mowry Rd, Suite 145 | Gainesville, FL 32610-3633

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