title: The joint effects of census tract poverty and geographic access on late-stage breast cancer diagnosis in 10 US States.
abstract: This study evaluated independent and joint effects of census tract (CT) poverty and geographic access to mammography on stage at diagnosis for breast cancer. The study included 161,619 women 40+ years old diagnosed with breast cancer between 2004 -2006 in ten participating US states. Multilevel logistic regression was used to estimate the odds of late-stage breast cancer diagnosis for the entire study population and by state. Poverty was independently associated with late-stage in the overall population (poverty rates >20% OR=1.30, 95% CI=1.26- 1.35) and for 9 of the 10 states. Geographic access was not associated with late-stage diagnosis after adjusting for CT poverty. State-specific analysis provided little evidence that geographic access was associated with breast cancer stage at diagnosis, and after adjusting for poverty, geographic access mattered in only 1 state. Overall, compared to women with private insurance, the adjusted odds ratios for late stage at diagnosis among women with either no insurance, Medicaid, or Medicare were 1.80 (95% CI = 1.65, 1.96), 1.75 (95% CI = 1.68, 1.84), and 1.05 (95% CI 1.01, 1.08), respectively. Although geographic access to mammography was not a significant predictor of late-stage breast cancer diagnosis, women in high poverty areas or uninsured are at greatest risk of being diagnosed with late-stage breast cancer regardless of geographic location and may benefit from targeted interventions.
authors: Department of Geography and Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, Salt Lake City, UT 84112, USA. kevin.henry@geog.utah.edu
authors: Kevin A
authors: KA
authors: Henry
authors: Recinda
authors: R
authors: Sherman
authors: Steve
authors: S
authors: Farber
authors: Myles
authors: M
authors: Cockburn
authors: Daniel W
authors: DW
authors: Goldberg
authors: Antoinette M
authors: AM
authors: Stroup
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D062306:Geography, Medical; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008327:Mammography / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data; D011204:Poverty Areas; D014481:United States / Q000453:epidemiology