title: Travel distance to screening facilities and completion of abnormal mammographic follow-up among disadvantaged women.
abstract: Although many studies have examined factors in predicting incomplete and delay in abnormal mammogram follow-up, few have used geospatial methods to examine these factors. Consequently, the purpose of this study was to examine the relationship between travel distance to health facilities and completion of abnormal mammogram follow-up among disadvantaged women in South Carolina.
  
  
  
  Women participating in South Carolina's Best Chance Network between 1996 and 2009 with abnormal mammogram were included in the study. Kaplan-Meier survival was used to describe the probability of work-up completion after abnormal mammogram among different distance categories, and Cox proportional hazards model was used to further assess the relationship between work-up completion and travel distance to the screening provider and mammography facility.
  
  
  
  Among 1,073 women, there was significant difference in time to completion of abnormal mammogram work-up by race; African American women had longer time to completion compared to European American women. Accounting for race, age, previous mammograms, income, and insurance status, women who lived closest to their diagnosing mammography facility were more likely to complete their work-up compared to those who lived the farthest (HR = 1.41; 95% CI = 1.00-1.80).
  
  
  
  Distance to the diagnosing mammography facility may play a role on the completion of abnormal mammogram work-up.
authors.affiliation: Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia. Electronic address: lkhang@csufresno.edu.
authors.forename: Leepao
authors.initials: L
authors.lastname: Khang
authors.affiliation: Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia; College of Nursing, University of South Carolina, Columbia.
authors.forename: Swann Arp
authors.initials: SA
authors.lastname: Adams
authors.affiliation: Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Steck
authors.affiliation: Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia.
authors.forename: Jiajia
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia.
authors.forename: Sudha
authors.initials: S
authors.lastname: Xirasagar
authors.affiliation: South Carolina Department of Health and Environmental Control, Bureau of Disease Control, Columbia, SC.
authors.forename: Virginie G
authors.initials: VG
authors.lastname: Daguise
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000639:trends*; D054625:Healthcare Disparities; D006801:Humans; D053208:Kaplan-Meier Estimate; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013022:South Carolina; D016019:Survival Analysis; D035862:Vulnerable Populations; D044465:White People / Q000706:statistics & numerical data
keywords: Abnormal mammograms; Breast cancer; GIS; Racial disparity