Geographic disparities in late-stage cancer diagnosis: Multilevel factors and spatial interactions

Mobley, Lee; Kuo, Tzy‐Mey; Watson, Lisa; Brown, G. Gordon

doi:10.1016/j.healthplace.2012.06.009

Cited by 30 publications

(43 citation statements)

References 40 publications

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“…Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, studies have examined low SES, marital status, race or ethnicity, distance to closest provider, managed care penetration, area screening rates, or residence in a racially segregated community as predictors of late-stage diagnosis [1,2]. Other studies which examined whole cancer populations in multiple states or regions in the US found that factors such as area poverty or deprivation, lack of personal insurance, or percent uninsured in the area have associations with late-stage BC diagnosis [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…A recent paper examined predictors of late-stage BC and CRC diagnoses during 2001–2005 in 11 SEER Registry states [1]. The analysis was representative of persons aged 65 or older who were eligible for Medicare, and linkages with the Medicare beneficiary files allowed ascertainment of marriage status and socioeconomic status (via the dual eligibility indicator).…”

Section: Introductionmentioning

confidence: 99%

“…One study concluded that opening up competition among plans across states would lower premiums and increase value in the benefits packages offered to consumers [10]. The late-stage cancer predictors paper [1] was novel, in that no previously published studies concerning health insurance regulations or mandates had examined their impacts on health outcomes, and conversely no previous studies of population cancer outcomes had included state-level factors such as health insurance regulations.…”

Section: Introductionmentioning

confidence: 99%

“…Using traditional multilevel modeling [11] with a random intercepts specification to produce robust area-level predictions from the large person-level analytic file, the researchers [1] pooled the data across the 11 SEER registry states. They used a very similar conceptual model to the one used in this paper (Figure 1, methods section below), to guide hypotheses regarding effects of particular insurance regulations or mandates that might impact cancer outcomes, limiting attention to those regulations or mandates that actually varied across the 11 states studied.…”

Section: Introductionmentioning

confidence: 99%

“…However, when there were no continuity of care laws, the effect of living in lower SES counties was, on average, a much higher rate late-stage diagnoses. That paper [1], examining cancer registry populations in 11 SEER Registry states, provided significant albeit preliminary evidence that the state insurance regulatory environment does impact whether people are diagnosed with breast or colorectal cancer at later stage.…”

Section: Introductionmentioning

confidence: 99%

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Geographic and Demographic Disparities in Late-stage Breast and Colorectal Cancer Diagnoses Across the US

Mobley

Kuo

2015

AIMS Public Health

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ProblemIn 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.PurposeUsing 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 both Why and Where demographic and geographic disparities in these diagnoses are observed.MethodsTo answer questions related to Why disparities are observed, we utilize a three-level, random-intercepts model including person-, local area-, and region- specific levels of influence. To answer questions related to Where disparities 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.ConclusionsEmpirical 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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Geographic and Demographic Disparities in Late-stage Breast and Colorectal Cancer Diagnoses Across the US

Mobley

Kuo

2015

AIMS Public Health

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Ethnic density and cancer: A review of the evidence

Fang

Tseng

2018

Cancer

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Accumulating data suggest that factors in the social environment may be associated with cancer-related outcomes. Ethnic density, defined as the proportion of racial/ethnic minority individuals residing in a given geographic area, is 1 of the most frequently studied social environment factors, but studies on ethnic density and cancer have yielded inconsistent findings. Thus, the objective of the current review was to summarize the extant data on ethnic density and cancer-related outcomes (cancer risk, stage at diagnosis, and mortality) with the aim of identifying pathways by which ethnic density may contribute to outcomes across populations. In general, the findings indicated an association between ethnic density and increased risk for cancers of infectious origin (eg, liver, cervical) but lower risk for breast and colorectal cancers, particularly among Hispanic and Asian Americans. Hispanic ethnic density was associated with greater odds of late-stage cancer diagnosis, whereas black ethnic density was associated with greater mortality. In addition, this review highlights several methodological and conceptual issues surrounding the measurement of ethnic neighborhoods and their available resources. Clarifying the role of neighborhood ethnic density is critical to developing a greater understanding of the health risks and benefits accompanying these environments and how they may affect racial and ethnic disparities in cancer-related outcomes. Cancer 2018;124:1877-903. © 2018 American Cancer Society.

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A statewide program providing colorectal cancer screening to the uninsured of South Carolina

Eberth

Thibault

Caldwell

et al. 2018

Cancer

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Geographic disparities in late-stage cancer diagnosis: Multilevel factors and spatial interactions

Cited by 30 publications

References 40 publications

Geographic and Demographic Disparities in Late-stage Breast and Colorectal Cancer Diagnoses Across the US

Geographic and Demographic Disparities in Late-stage Breast and Colorectal Cancer Diagnoses Across the US

Ethnic density and cancer: A review of the evidence

A statewide program providing colorectal cancer screening to the uninsured of South Carolina

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