Abstract A01: No Maryland county left behind: Statewide intervention may reduce geographic disparities.

Introduction: Recent Maryland cancer planning, funding and consensus building efforts and prior screening for breast and cervical cancer have successfully reduced mortality rates and racial disparities over time. Nevertheless geographical disparities among Maryland counties have not been examined. To date assessment of racial disparities has been accomplished using the Index of Disparity. To evaluate geographic disparities and whether every county is improving regardless of its size we suggest utilization of coefficient of variation (CV), skewness and kurtosis. We investigated geographic disparities in county cancer mortality over three time periods and between Maryland and the five adjacent states. Methods: Using data from CDC WONDER, we assessed county breast (female), colon/rectal, lung, and prostate (male) cancer mortality coefficient of variation, skewness, and kurtosis relative to a priori critical values. Results: Maryland counties showed a coefficient of variation consistent with adjacent state counties. In both geographic areas, breast and colon/rectum coefficients of variation were statistically below 0.25. Skewness among Maryland counties was not significant in any time period or any site except prostate cancer, significantly positive (1.36, 95% confidence intervals: 0.43-2.29) only during 1994-98. Only the adjacent state counties exhibited statistically significant skewness and kurtosis for each cancer site at some time. Coefficient of variation is most often slightly smaller than the Index of Disparity due to the larger average of county rates relative to the overall rate (weighted by county). Conclusion: With statewide funding since 1990, Maryland has eliminated geographic disparities in breast and colon/rectum cancer but continues to exhibit borderline lung/bronchus and significant prostate disparities exhibited by “large” coefficient of variation but not – skewness and kurtosis in 2004-2008. We suggest that absence of skewness and kurtosis may be a further indication of county disparities reduction. Tracking of disparities across counties indicated whether statewide or county-specific interventions was needed and whether progress toward elimination of disparities was made. The ideal progression of geographic disparities is indicated by a resultant very small coefficient of variation; left, if any skewness; and no kurtosis. Maryland is on track to accomplish this in all four cancer mortality indicators and on target for breast and colon and rectum. Citation Format: Christina M. Bischoff, Norma F. Kanarek. No Maryland county left behind: Statewide intervention may reduce geographic disparities. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A01.