# Prevalence of clinician-ordered genetic testing in rural and urban United States counties: An analysis of the 2022 Health Information National Trends Survey

## TL;DR

This study found no significant difference in genetic testing rates between rural and urban areas in the U.S., suggesting geography may not impact access for those aware of genetic testing.

## Contribution

The study is the first to analyze the association between rurality and clinician-ordered genetic testing using a nationally representative survey.

## Key findings

- Rurality was not associated with the prevalence of reproductive carrier or disease risk genetic testing.
- Different demographic factors were linked to different types of genetic testing.
- Genetic test use may not explain health disparities between rural and urban areas.

## Abstract

Rural residents face challenges to realizing guideline-concordant healthcare. Less is known about the role of rurality in achieving guideline-concordant genetic testing. To address this gap, we estimated the association between rural residence and two types of clinician-ordered genetic testing among individuals who had heard of genetic testing.

In 2024, we considered the 4559 individuals (80.0 % of respondents) who indicated that they had heard of genetic testing in the cross-sectional Health Information National Trends Survey wave 6, collected in the United States, March 7 – November 8, 2022, to assess the association between rurality and two types of clinician-ordered genetic testing, reproductive carrier and disease risk testing. Log binomial regression models estimated the prevalence ratios of two types of guideline-concordant clinician-ordered genetic testing while adjusting for sociodemographic characteristics.

Of the 4559 respondents assessed for eligibility, 976 and 3933 responses were eligible for analysis of clinician-ordered reproductive genetic carrier testing and disease risk testing, respectively. The prevalence of clinician-ordered reproductive carrier and disease risk genetic testing did not vary by rurality in adjusted multivariable regression analyses (adjusted prevalence ratio (aPR): 0.71, 95 % CI 0.38–1.33, aPR: 1.23, 95 % CI 0.86–1.75, respectively). Post hoc we identified significant differences in different covariate aPRs in both types of clinician-ordered genetic testing.

Clinician-ordered genetic testing does not appear to be associated with geography among individuals who have heard of genetic testing. Post hoc differences in factors associated with each type of testing suggest pathways by which the differences in use may occur.

•Rurality was not associated with clinician-ordered genetic testing prevalence.•Different demographic factors associated with different types of genetic tests.•Genetic test use may not underlie health differences in rural and urban counties.

Rurality was not associated with clinician-ordered genetic testing prevalence.

Different demographic factors associated with different types of genetic tests.

Genetic test use may not underlie health differences in rural and urban counties.