The role of poverty rate and racial distribution in the geographic clustering of breast cancer survival among older women: a geographic and multilevel analysis.
The authors examined disparities in survival among women aged 66 years or older in association with census-tract-level poverty rate, racial distribution, and individual-level factors, including patient-, treatment-, and tumor-related factors, utilization of medical care, and mammography use. They used linked data from the 1992-1999 Surveillance, Epidemiology, and End Results (SEER) programs, 1991-1999 Medicare claims, and the 1990 US Census. A geographic information system and advanced statistics identified areas of increased or reduced breast cancer survival and possible reasons for geographic variation in survival in 2 of the 5 SEER areas studied. In the Detroit, Michigan, area, one geographic cluster of shorter-than-expected breast cancer survival was identified (hazard ratio (HR) = 1.60). An additional area where survival was longer than expected approached statistical significance (HR = 0.4; P = 0.056). In the Atlanta, Georgia, area, one cluster of shorter- (HR = 1.81) and one cluster of longer-than-expected (HR = 0.72) breast cancer survival were identified. Stage at diagnosis and census-tract poverty (and patient's race in Atlanta) explained the geographic variation in breast cancer survival. No geographic clusters were identified in the 3 other SEER programs. Interventions to reduce late-stage breast cancer, focusing on areas of high poverty and targeting African Americans, may reduce disparities in breast cancer survival in the Detroit and Atlanta areas.
Schootman
Mario
M
Department of Medicine and Pediatrics, Division of Health Behavior Research, Washington University School of Medicine, Saint Louis, MO, USA. mschootm@dom.wustl.edu
Jeffe
Donna B
DB
Lian
Min
M
Gillanders
William E
WE
Aft
Rebecca
R
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics / Q000208:ethnology* / Q000401:mortality*; D019352:Censuses; D005260:Female; D040362:Geographic Information Systems; D054624:Health Status Disparities; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data; D006278:Medicare; D009367:Neoplasm Staging; D011203:Poverty / Q000208:ethnology / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012307:Risk Factors; D018426:SEER Program; D017062:Small-Area Analysis; D016019:Survival Analysis; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data