title: Temporal trends in area socioeconomic disparities in breast-cancer incidence and mortality, 1988-2005.
abstract: Since an overarching goal of Healthy People 2010 was to eliminate health disparities, we determined temporal trends in socioeconomic disparities in five breast-cancer indicators (in situ, stage I, lymph-node positive, and locally advanced breast-cancer incidence, and breast-cancer mortality) by county socioeconomic deprivation using 1988-2005 population-based breast-cancer data. Using 1988-2005 data from women aged 40 and older from 200 counties in the Surveillance, Epidemiology, and End Results program, we examined trends in temporal disparities in the five breast-cancer indicators across quartiles of county socioeconomic deprivation. County-level trends were summarized using the estimated annual percentage change. Observed county rates were smoothed using Bayesian hierarchical spatiotemporal methods to calculate measures of absolute and relative disparity (using absolute and relative concentration indices) and their changes over time. Large increases in in situ breast cancer rates since 1988 were observed for each of the deprivation quartiles. Absolute and relative disparity both increased over time, suggesting increasing disparities across levels of county deprivation. Absolute and relative concentration indices were near zero for the other four breast-cancer indicators, suggesting no disparities among the four quartiles of county deprivation during 1988-2005. Efforts to target counties aimed at increasing breast-cancer screening based on their level of deprivation will not likely be beneficial.
authors.affiliation: Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, Box 8504, 4444 Forest Park Avenue, St Louis, MO 63108, USA. mschootm@wustl.edu
authors.forename: Mario
authors.initials: M
authors.lastname: Schootman
authors.forename: Min
authors.initials: M
authors.lastname: Lian
authors.forename: Anjali D
authors.initials: AD
authors.lastname: Deshpande
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Baker
authors.forename: Sandi L
authors.initials: SL
authors.lastname: Pruitt
authors.forename: Rebecca
authors.initials: R
authors.lastname: Aft
authors.forename: Donna B
authors.initials: DB
authors.lastname: Jeffe
mesh_terms: D000328:Adult; D001499:Bayes Theorem; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D054624:Health Status Disparities; D006305:Health Status Indicators; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis; D008390:Markov Chains; D008403:Mass Screening; D009010:Monte Carlo Method; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011203:Poverty; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology