Abstract C056: Enhanced National Cancer Institute (NCI) data resources to support research on area-level context and cancer-related outcomes

Abstract

Abstract Background: Area-level poverty and rurality are associated with cancer risk, access to cancer screening and early symptom assessment, early diagnosis, treatment, survivorship care, and outcomes. However, less is known about other social, economic, and environmental factors that shape the contexts in which people live, age, and receive care. Using a newly developed data linkage with the NCI’s Surveillance, Epidemiology, and End Results (SEER)-Medicare and SEER-Medicaid datasets, we report census-tract (CT) level contextual measures stratified and compared by area-level poverty and urban/rural residence. Methods: We used SEER-Medicaid data to capture demographic, cancer-related measures, and urban/rural residence, and linked to contextual data from the American Community Survey, the USDA Food Atlas, the Home Mortgage Disclosure Act, Environmental Justice Index, the Area Health Resources Files, and the CDC Social Vulnerability Index and Places datasets. Inclusion criteria: adults aged 19-64 years diagnosed with a first primary invasive cancer (10 highest incidence cancers in age group) between 2008-2021 with any insurance status. CT-level measures included: poverty status (persistent poverty (PP) ≥20% over 30 years, current high poverty ≥20% but <30 years, moderate poverty 10-19%, and lower poverty <10%), low educational attainment, low food access, rent >30% of income, uninsured, receiving public income or food support, and environmental exposures. Bivariate analyses described linked sample distributions overall, with stratification and comparison across poverty status and urban/rural residence. Results: Among the 2,522,415 cancer survivors, 53.5% were in the 55-64 age group; 58.4% were female, 65.4% non-Hispanic white, 27.6% of cases were breast cancer; 89.9% resided in urban areas, 6.2%, 18.3% and 28.0% resided in CTs designated as persistent, other high, and moderate poverty levels, respectively. Rural areas accounted for 31.1% of persistent poverty and only 4.0% of those in lower poverty areas. Overall, 13.7% had <12 years of education, with 7.6% unemployment, 15.8% uninsurance; 2.7% with public income support and 11.4% food assistance; 16.2% had no internet access. Persistent and current high poverty area residents experienced greater levels of socioeconomic disadvantage. Findings related to housing cost, occupancy, low food access, and other measures revealed mixed patterns across poverty status categories and urban/rural residence, and across poverty categories when stratified by urban/rural residence. Conclusions: Understanding area-level characteristics is critical to examining drivers of cancer-related care, and to inform the context for potential interventions. NCI has identified a rich set of linkable area-level measures to support this research and will continue to monitor and respond to evolving research needs. Citation Format: Amy J. Davidoff, Imani Canton, Michelle Doose. Enhanced National Cancer Institute (NCI) data resources to support research on area-level context and cancer-related outcomes [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr C056.