title: Impact of Urban Neighborhood Disadvantage on Late Stage Breast Cancer Diagnosis in Virginia.
abstract: Research suggests that residents of inner-city urban neighborhoods have higher rates of late stage cancer diagnosis. Identifying urban neighborhoods with high rates of both concentrated disadvantage and late stage cancer diagnosis may assist health care providers to target screening interventions to reduce disparities. The purposes of this study were to (1) create an index to evaluate concentrated disadvantage (CD) using non-racial measures of poverty, (2) determine the impact of neighborhood CD on late stage breast cancer diagnosis in US cities, and (3) to understand the role of obesity on this relationship. We used census block group- (CBG) level poverty indicators from five Virginia cities to develop the index. Breast cancer cases of women aged 18-65 who lived in the five cities were identified from the 2000-2012 Virginia Cancer Registry. A logistic regression model with random intercept was used to evaluate the impact of disadvantage on late stage breast cancer diagnosis. CBG-level maps were developed to geographically identify neighborhoods with both high rates of CD and late breast cancer staging. Over 900 CBGs and 6000 breast cases were included. Global fit of the concentrated disadvantage model was acceptable. The effect of disadvantage on late stage was significant (OR = 1.0083, p = 0.032). Inner-city poverty impacts risk of late stage breast cancer diagnosis. Area-level obesity is highly correlated with neighborhood poverty (ρ = 0.74, p < 0.0001) but the mediating direct and indirect effects are non-significant. Intervening in these high poverty neighborhoods may help combat disparities in late stage diagnosis for urban poor and for minorities living in these underserved neighborhoods, but more study is needed to understanding the complex relationship between concentrated neighborhood poverty, obesity, and late stage diagnosis.
authors.affiliation: University of Virginia School of Nursing, PO Box 800782, Charlottesville, VA, 22908-0782, USA. deguzman@virginia.edu.
authors.forename: Pam Baker
authors.initials: PB
authors.lastname: DeGuzman
authors.affiliation: Department of Public Health, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Wendy F
authors.initials: WF
authors.lastname: Cohn
authors.affiliation: Department of Public Health, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Fabian
authors.initials: F
authors.lastname: Camacho
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Brandy L
authors.initials: BL
authors.lastname: Edwards
authors.affiliation: Department of Public Health, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Vanessa N
authors.initials: VN
authors.lastname: Sturz
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Anneke T
authors.initials: AT
authors.lastname: Schroen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology / Q000473:pathology*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009367:Neoplasm Staging; D009765:Obesity / Q000453:epidemiology* / Q000208:ethnology; D011203:Poverty / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D018426:SEER Program; D062206:Spatial Analysis; D014504:Urban Health; D014768:Virginia / Q000453:epidemiology; D055815:Young Adult
keywords: Breast cancer; Concentrated disadvantage; Neighborhood; Poverty; Stage of diagnosis; Urban health