title: Geographic and Demographic Disparities in Late-stage Breast and Colorectal Cancer Diagnoses Across the US.
abstract: OBJECTIVE
  In 2009, breast cancer was the most common cancer in women, and colorectal cancer was the third most common cancer in both men and women. Currently, the majority of colorectal and almost 1/3 of breast cancers are diagnosed at an advanced stage in the US, which results in higher morbidity and mortality than would obtain with earlier detection. The incidence of late-stage cancer diagnoses varies considerably across the US, and few analyses have examined the entire US.
  
  
  OBJECTIVE
  Using the newly available US Cancer Statistics database representing 98% of the US population, we perform multilevel analysis of the incidence of late-stage cancer diagnoses and translate the findings via bivariate mapping, answering questions related to bothWhyandWheredemographic and geographic disparities in these diagnoses are observed.
  
  
  METHODS
  To answer questions related toWhydisparities are observed, we utilize a three-level, random-intercepts model including person-, local area-, and region- specific levels of influence. To answer questions related toWheredisparities are observed, we generate county level robust predictions of late-stage cancer diagnosis rates and map them, contrasting counties ranked in the upper and lower quantiles of all county predicted rates. Bivariate maps are used to spatially translate the geographic variation among US counties in the distribution of both BC and CRC late-stage diagnoses.
  
  
  CONCLUSIONS
  Empirical modeling results show demographic disparities, while the spatial translation of empirical results shows geographic disparities that may be quite useful for state cancer control planning. Late stage BC and CRC diagnosis rates are not spatially random, manifesting as place-specific patterns that compare counties in individual states to counties across all states. Providing a relative comparison that enables assessment of how results in one state compare with others, this paper is to be disseminated to all state cancer control and central cancer registry program officials.
authors.affiliation: Spatial Science and Health Economics, School of Public Health and Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA.
authors.forename: Lee R
authors.initials: LR
authors.lastname: Mobley
authors.affiliation: Lineberger Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Tzy-Mey May
authors.initials: TM
authors.lastname: Kuo
keywords: cancer control; demographic disparity; geographic disparity; late-stage cancer diagnosis; multilevel modeling; translational mapping