Spatial association of racial/ethnic disparities between late-stage diagnosis and mortality for female breast cancer: where to intervene?

Abstract

BackgroundOver the past twenty years, racial/ethnic disparities between late-stage diagnoses and mortality outcomes have widened due to disproportionate medical benefits that different racial/ethnic groups have received. Few studies to date have examined the spatial relationships of racial/ethnic disparities between breast cancer late-stage diagnosis and mortality as well as the impact of socioeconomic status (SES) on these two disparities at finer geographic scales.MethodsThree methods were implemented to assess the spatial relationship between racial/ethnic disparities of breast cancer late-stage diagnosis and morality. First, this study used rate difference measure to test for racial/ethnic disparities in both late-stage diagnosis and mortality of female breast cancer in Texas during 1995-2005. Second, we used linear and logistic regression models to determine if there was a correlation between these two racial/ethnic disparities at the census tract level. Third, a geographically-weighted regression analysis was performed to evaluate if this correlation occurred after weighting for local neighbors.ResultsThe spatial association of racial disparities was found to be significant between late-stage diagnosis and breast cancer mortality with odds ratios of 33.76 (CI: 23.96-47.57) for African Americans and 30.39 (CI: 22.09-41.82) for Hispanics. After adjusting for a SES cofounder, logistic regression models revealed a reduced, although still highly significant, odds ratio of 18.39 (CI: 12.79-26.44) for African-American women and 11.64 (CI: 8.29-16.34) for Hispanic women. Results of the logistic regression analysis indicated that census tracts with low and middle SES were more likely to show significant racial disparities of breast cancer late-stage diagnosis and mortality rates. However, values of local correlation coefficients suggested that the association of these two types of racial/ethnic disparities varied across geographic regions.ConclusionsThis study may have health-policy implications that can help early detection of breast cancer among disadvantaged minority groups through implementing effective intervention programs in targeted regions.

Neighborhood-level Influences on Delays in Diagnostic Follow-up from Mammography Screening in African-American Women: A Systematic Review

“…Age and marital status, and distance within three miles radius of MS facilities were statistically significant for advanced breast cancer for Hispanic and White women, but not for Black women (p<0.05). Davidson et al and Tian et al [23,27] found similar results in late-diagnosis of breast cancer for Hispanic women, but not for Asian or White women.…”

“…Three studies did not report mean or median age of the study population [27].Two studies compared data in metropolitan suburbs with a higher concentration of minority population [27]. One study comprised a large populace of women in 11 heterogeneous states [18], while another study consisted of several states as part of the Cancer Research Network (Table 1) [33].…”

“…Odds ratios (OR) and weighted means were calculated at the 95% Confidence Interval (CI) with multivariate analysis calculating relative risk. Twelve of the 17 studies (67%) examined relationships between residence in disadvantaged neighborhoods and Socio-Economic Status (SES) (age ≥ 45 years, lower education and median household income, and lack of insurance) and delays in diagnostic follow-up from abnormal MS or late-diagnosis of breast cancer [17,[20][21][22][23][24][25][26][27][28]. Three studies examined racial segregation on delays in diagnostic follow-up [18,21,29]; while two studies examined relationships between raciallysegregated neighborhoods and lack of primary care providers and radiologists on later-stage diagnosis of breast cancer.…”

Impact of Chronic Conditions on the Cost of Cancer Care for Medicaid Beneficiaries

“…Overall, about 45% of all cancers are diagnosed among those younger than 65 years, and the average length of survival following breast cancer diagnosis has been shown to be substantially lower among low-income people than among those with higher incomes, even in studies that controlled for cancer stage at the time of diagnosis (Tian, Wilson, & Zhan, 2011;Freeman, Ricardo, Campbell, Barrett, & Warnecke, 2011). About 60% of adult Medicaid enrollees have a chronic or disabling condition (Boyd et al, 2010).…”

Spatio-Temporal Differentiation of Cancer Incidence in Slovakia

“…For example, breast cancer is more common in higher socio-economic classes and among women whereas lung cancer is more common in lower classes and mainly among men who smoke . On the other hand, cancers do not generally show such a strong relation to social classes as cardiovascular diseases (Hiatt and Breen, 2008;Tian et al, 2011) .…”