title: Spatial association of racial/ethnic disparities between late-stage diagnosis and mortality for female breast cancer: where to intervene?
abstract: BACKGROUND
  Over 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.
  
  
  METHODS
  Three 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: Texas Center for Geographic Information Science, Department of Geography, Texas State University-San Marcos, 601 University Drive, San Marcos, Texas 78666, USA. jt1277@txstate.edu
authors.forename: Nancy
authors.initials: N
authors.lastname: Tian
authors.forename: J Gaines
authors.initials: JG
authors.lastname: Wilson
authors.forename: F Benjamin
authors.initials: FB
authors.lastname: Zhan
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000401:mortality*; D005006:Ethnicity / Q000208:ethnology*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D009367:Neoplasm Staging / Q000401:mortality*; D044469:Racial Groups / Q000208:ethnology*; D012042:Registries; D013781:Texas / Q000208:ethnology; D013997:Time Factors