WMJ Vol 120 Issue 2: Cancer Mortality and Research Outcomes in a Rural State
Background: North Dakota is a rural state with high rates of cancer. Determining how various demographic, geographic, and funding factors contributed to cancer incidence on a state and county level helps improve cancer prevention and control.
Objectives: We examined cancer incidence rate trends by demographic (sex and ethnicity) and geographic (county, population, rural/frontier status) factors. We also examined cancer funding and research output by year.
Methods: Cancer incidence rates were obtained from the North Dakota Cancer Registry and stratified by sex, ethnicity, and county. US cancer rates also were obtained for comparison. Generalized linear models were used to compare overall incidence rates and yearly trends.
Results: Male melanoma incidence rates increased faster than the US average across year P = 0.020). Incidence rates for prostate, lung, and colorectal cancer among American Indians/Alaska Natives (AI/AN) decreased faster than Whites across year (P < 0.001, P = 0.001, P < 0.001, respectively). Four counties—2 for breast cancer and 2 for prostate cancer—had differential trends compared to the North Dakota average across year (P = 0.011, P = 0.029; P = 0.046, P = 0.042). County-level lung cancer incidence rates were positively correlated with county population size, while rates for cervix/uteri were negatively correlated (P = 0.001, P = 0.023). Funding from the National Institutes of Health for North Dakota increased across year along with cancer papers published increased (P < 0.001, P < 0.001).
Conclusions: Examining state and county data revealed several surprising trends and the need for a more fine-scale approach to cancer cause, control, and prevention.
The target audience for this journal-based activity is healthcare providers caring for the people and communities of Wisconsin and beyond.
As a result of this journal-based activity, the healthcare team will be able to:
- Discuss male melanoma incidence rates increase, differences between incidence rates for prostate, lung, and colorectal cancer among American Indians/Alaska Natives and Whites, and other findings regarding cancer incidence rates by sex and ethnicity in North Dakota.
- Explain cancer incidence rate trends in North Dakota by geographic factors (ie, county, population, rural/frontier status).
- Reflect on the data about cancer funding and research output generated by the study.
It is the policy of the University of Wisconsin–Madison Interprofessional Continuing Education Partnership (ICEP) to identify, mitigate and disclose all relevant financial relationships with ineligible companies* held by the speakers/presenters, authors, planners, and other persons who may influence content of this accredited continuing education (CE). In addition, speakers, presenters and authors must disclose any planned discussion of unlabeled/unapproved uses of drugs or devices during their presentation.
For this accredited continuing education activity all relevant financial relationships have been mitigated and detailed disclosures are listed below.
|Name of Individual||Individual's Role in Activity|
Name of Commercial Interest &
|Marianna Shershneva, MD, PhD||Accreditation Specialist||No relevant relationships with ineligible companies to disclose||No|
|Mark R. Williamson, PhD||Author||No relevant relationships with ineligible companies to disclose||No|
|Rashid M. Ahmed, PhD||Author||No relevant relationships with ineligible companies to disclose||No|
|Dennis J. Baumgardner, MD||Reviewer||No relevant relationships with ineligible companies to disclose||No|
|Alex Means, MD||Reviewer||No relevant relationships with ineligible companies to disclose||No|
|Sarina Schrager, MD, MS||Editor||No relevant relationships with ineligible companies to disclose||No|
*Ineligible companies are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on, patients.
The ACCME does not consider providers of clinical services directly to patients to be ineligible companies.
|In support of improving patient care, this activity has been planned and implemented by the University of Wisconsin–Madison ICEP and the Wisconsin Medical Journal. The University of Wisconsin–Madison ICEP is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.|
Credit Designation Statements
American Medical Association (AMA)
The University of Wisconsin–Madison ICEP designates this journal-based CE activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Education Units
The University of Wisconsin–Madison ICEP, as a member of the University Professional & Continuing Education Association (UPCEA), authorizes this program for 0.1 continuing education units (CEUs) or 1 hour.
- 1.00 AMA PRA Category 1 Credit™
- 1.00 University of Wisconsin–Madison Continuing Education Hours
- 1.00 Approved for AMA PRA Category 1 Credit™
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