title: Influence of primary care physician availability and socioeconomic deprivation on breast cancer from 1988 to 2008: a spatio-temporal analysis.
abstract: BACKGROUND
  Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States. It is unclear how county-level primary care physician (PCP) availability and socioeconomic deprivation affect the spatial and temporal variation of breast cancer incidence and mortality.
  
  
  METHODS
  We used the 1988-2008 public-use county-based data from nine Surveillance, Epidemiology, and End Results (SEER) programs to analyze the temporal and spatial disparity of PCP availability and socioeconomic deprivation on early-stage incidence, advanced-stage incidence and breast cancer mortality. The spatio-temporal analysis was implemented by a novel structural additive modeling approach.
  
  
  RESULTS
  Greater PCP availability was significantly associated with higher early-stage incidence, advanced-stage incidence and mortality during the entire study period while socioeconomic deprivation was significantly negatively associated with early-stage incidence, advanced-stage incidence, and mortality up to 1992. However, the observed influence of PCP availability and socioeconomic deprivation varied by county.
  
  
  CONCLUSIONS
  We showed important associations of PCP availability and socioeconomic deprivation with the three breast cancer indicators. However, the effect of these associations varied over time and across counties. The association of PCP availability and socioeconomic deprivation was stronger in selected counties.
authors.affiliation: Division of Health Behavior Research, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America. lchien@dom.wustl.edu
authors.forename: Lung-Chang
authors.initials: LC
authors.lastname: Chien
authors.forename: Anjali D
authors.initials: AD
authors.lastname: Deshpande
authors.forename: Donna B
authors.initials: DB
authors.lastname: Jeffe
authors.forename: Mario
authors.initials: M
authors.lastname: Schootman
mesh_terms: D001499:Bayes Theorem; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D015233:Models, Statistical; D009367:Neoplasm Staging; D011320:Primary Health Care; D012044:Regression Analysis; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology