Federally qualified health centers were designed to promote healthcare access for the nation's most vulnerable populations, but according to new data from the University of Georgia, there are steep income-based disparities in cancer screening access at these facilities.
The study, published in the Journal of General Internal Medicine, found that FQHCs located in under-resourced neighborhoods -- such as low-income neighborhoods, places with higher unemployment rates and areas with lower average educational attainment -- tend to have lower cancer screening rates than FQHCs in better-resourced areas.
These findings are concerning, as FQHCs were designed to be a healthcare safety net, connecting traditionally marginalized or low-income folks to primary and preventive care. This latest study shows that even within this system, the most vulnerable are falling through the cracks.
What's more, these populations tend to have more complex health needs, according to Eunhae Shin, the study's lead author and an assistant professor in UGA's College of Public Health.
"These findings are really concerning because studies have shown that people in these more vulnerable areas tend to have a poorer diet, are not involved in physical activities and have a higher tobacco utilization rate," Shin said in a press release. "Those factors lead to a higher risk of developing cancer. Yet they are not getting services that can be lifesaving."
Shin and her team used data from the 2022 Health Resources and Services Administration Uniform Data System for 1,312 FQHCs to compare cancer screening rates at those with the highest and lowest social vulnerability index (SVI) scores.
Across the three cancer screenings included in the study -- breast, cervical and colorectal cancer screenings -- there were steep disparities.
For example, the cervical cancer screening rate was 7.8 percentage points lower at FQHCs in the most socially vulnerable neighborhoods compared to the least socially vulnerable neighborhoods. For breast cancer screening, that difference was 10.9 percentage points, and for colorectal cancer screening, it was 15.3 percentage points.
These health disparities are driven in large part by income, with the researchers noting that the socioeconomic status subdomain of the SVI, which includes factors such as poverty, unemployment, income and education, had the strongest correlation with lower cancer screening rates.
Other factors like race and ethnicity, language preference and social determinants of health, such as housing and transportation access, influenced cancer screening rates.
Augmenting patient outreach for cancer screening
According to Shin, these findings indicate a problem with patient navigation.
"Those who live in areas with low education levels and low income face a lot of logistical barriers to receiving preventive services," Shin explained.
The research team suggested that more tailored patient outreach and population health management could help close the cancer screening gap.
"Strengthening how these centers use social risk screening and connect patients to support within preventive care workflows can also help address challenges such as transportation difficulties, limited health literacy, and competing social needs that often impede timely screening," the researchers wrote in the study.
Additionally, the researchers recommended using alternative cancer screening methods, such as mail-in test kits.
This could be particularly effective for boosting colorectal cancer screening rates, which saw the biggest disparity in testing.
Better FQHC reimbursement, plus other policy changes, will be key to implementing those population health strategies, Shin acknowledged.
"We need to pay more attention to these FQHC patients. When we talk about health systems, people talk about hospitals and physicians, but FQHCs play such an important role," she said. "More research should be done in this area, and there needs to be more policy attention to improve not only cancer disparities but disparities in other chronic conditions as well."
Sara Heath has reported news related to patient engagement and health equity since 2015.
