Assessing health disparities in breast cancer incidence burden in Tennessee: geospatial analysis

Abstract

Background Tennessee women experience the 12th highest breast cancer mortality in the United States. We examined the geographic differences in breast cancer incidence in Tennessee between Appalachian and non-Appalachian counties from 2005 to 2015. Methods We used ArcGIS 10.7 geospatial analysis and logistic regression on the Tennessee Cancer Registry incidence data for adult women aged ≥ 18 years (N = 59,287) who were diagnosed with breast cancer from 2005 to 2015 to evaluate distribution patterns by Appalachian county designation. The Tennessee Cancer Registry is a population-based, central cancer registry serving the citizens of Tennessee and was established by Tennessee law to collect and monitor cancer incidence. The main outcome was breast cancer stage at diagnosis. Independent variables were age, race, marital status, type of health insurance, and county of residence. Results Majority of the sample were White (85.5%), married (58.6%), aged ≥ 70 (31.3%) and diagnosed with an early stage breast cancer (69.6%). More than half of the women had public health insurance (54.2%), followed by private health insurance coverage (44.4%). Over half of the women resided in non-Appalachian counties, whereas 47.6% were in the Appalachian counties. We observed a significant association among breast cancer patients with respect to marital status and type of health insurance coverage (p = < 0.0001). While the logistic regression did not show a significant result between county of residence and breast cancer incidence, the spatial analysis revealed geographic differences between Appalachian and non-Appalachian counties. The highest incidence rates of 997.49–1164.59/100,000 were reported in 6 Appalachian counties (Anderson, Blount, Knox, Rhea, Roane, and Van Buren) compared to 3 non-Appalachian counties (Fayette, Marshall, and Williamson). Conclusions There is a need to expand resources in Appalachian Tennessee to enhance breast cancer screening and early detection. Using geospatial techniques can further elucidate disparities that may be overlooked in conventional linear analyses to improve women’s cancer health and associated outcomes.

Sociodemographic Factors and Health Insurance Coverage Are Associated with Invasive Breast Cancer in Tennessee: Appalachian and Non-Appalachian County Comparison

“…This finding aligns with a recently published study that investigated geographic differences in late stage BC diagnosis in Tennessee. 27 However, the study also found that of the 9 Tennessee counties with the highest incidence rates, six fall within Appalachia. 27 …”

“… 27 However, the study also found that of the 9 Tennessee counties with the highest incidence rates, six fall within Appalachia. 27 …”

“…A finding that is consistent with another recently published study. 27 Despite this result, racial disparities in BC mortality in the U.S. persist at striking levels. While BC incidence rates among non-Hispanic White and Black women are similar, Black women have a 41% higher mortality rate.…”

Relationship quality and psychophysiological distress for underserved breast cancer patients and their caregiver before treatment

“…This reverse association may be unique to pre-treatment because of anticipatory anxiety of the unknown treatment process, and marital quality could be linked to lower distress during treatment, as evidenced in other research. 3,11,34 However, such a reverse effect does expand the BBFM hypotheses to include how the effect of perceived threats to the relationship may trigger BBR dysregulation differently.…”

“…Breast cancer is the leading cancer diagnosed among US women, 1 with most (80%) having Estrogen Receptor Positive (ER+) tumors 2 . However, for the 2.9 million people living in East Tennessee (the Appalachian region of the state), the incidence of breast cancer is almost two times higher, 3 with significantly worse survival rates 4 . During breast cancer treatment—which can include surgery, chemotherapy, radiation, or adjuvant endocrine therapy, patients and their caregivers (e.g., family member, spouse, friend) often experience increased biobehavioral reactivity, which includes psychological (e.g., depressed mood) and physiological (e.g., pain, fatigue) dysregulation symptoms 5–7 .…”