The California Neighborhoods Data System: a new resource for examining the impact of neighborhood characteristics on cancer incidence and outcomes in populations

Background The effect of neighborhood and healthcare access factors on cancer outcomes among patients enrolled in navigator programs is not clearly understood. This study assessed associations between: 1) neighborhood factors and diagnostic time to resolution (TTR) and, 2) geographic access and TTR following an abnormal breast or cervical cancer screening test among women participating in the Ohio Patient Navigator Research Program (OPNRP). Methods Patient (demographic, socioeconomic status [SES], home-to-clinic distance) and neighborhood (deprivation, racial segregation) characteristics of 801 women living in one of 285 census tracts (CTs) in greater Columbus, Ohio were examined. Randomization to receive navigation occurred at the clinic level. Multilevel Cox regression and spatial analysis were used to estimate effects of various factors on TTR and assess model assumptions, respectively. Results TTR increased as neighborhood deprivation increased. After adjustment for age, friend social support, education and healthcare status, the TTR among women living in a neighborhood with a moderate median household income (between $36,147 and $53,099) was shorter compared to women living in low median household income neighborhoods (< $36,147) (p < 0.05). There is little evidence that unmeasured confounders are geographically patterned. Conclusions Increased neighborhood socioeconomic deprivation was associated with longer TTR following an abnormal breast or cervical cancer screening test. Impact These results highlight the need for addressing patient- and neighborhood-level factors to reduce cancer disparities among underserved populations.

Section: Methodsmentioning

confidence: 99%

Neighborhood Factors Associated with Time to Resolution Following an Abnormal Breast or Cervical Cancer Screening Test

Plascak

Llanos

Pennell

et al. 2014

“…Each census tract was assigned this composite score and categorized in quintiles based on the statewide distribution. Supplementary Table S1 (20) shows the distribution of the 7 census-based indicator variables of SES and the racial/ethnic distribution for each SES quintile. In the lowest SES quintile (Q1), the mean years of education was 11 years in comparison to 15 years in the highest quintile (Q5); the median household income was $28,335 versus $89,254 in Q1 v. Q5, respectively.…”

Section: Methodsmentioning

confidence: 99%

Examining the Association Between Socioeconomic Status and Invasive Colorectal Cancer Incidence and Mortality in California

Steinbrecher

Fish

Clarke

et al. 2012

Background Colorectal cancer (CRC) incidence and mortality rates vary across race/ethnicity. Socioeconomic status (SES) also influences CRC rates; however, these associations might be inconsistent across racial/ethnic groups and tumor subsite. We examined associations between area-level SES and CRC incidence and mortality in a population-based registry study of non-Hispanic Whites, African Americans, Hispanics, and Asians/Pacific Islanders from California. Methods Data on 52,608 incident CRC cases (1998–2002) and 14,515 CRC deaths (1999–2001) aged ≥50 years were obtained from the California Cancer Registry. Based on 2000 U.S. Census data, each cancer case and death was assigned a multidimensional census tract-level SES index. SES-specific quintiles of CRC incidence and mortality rates, incidence rate ratios (IRR) and mortality rate ratios, and 95% confidence intervals (CI) were estimated. Analyses were stratified by anatomical site, including left- versus right-sided tumors, race/ethnicity, and stage of disease. Results Overall CRC incidence and SES did not show a clear association, yet patterns of associations varied across tumor subsite and race/ethnicity. Positive associations between SES and CRC incidence were found in Hispanics [SES Q5 v. Q1: IRR = 1.54, CI = 1.39–1.69], irrespective of the subsite. For Whites [SES Q5 v. Q1: IRR = 0.80, CI = 0.77–0.83], and African Americans [SES Q5 v. Q1: IRR = 0.83, CI = 0.70–0.97] inverse associations were observed, predominantly for left-sided tumors. Mortality rates declined with increasing SES in Whites, whereas in Hispanics mortality rates significantly increased with SES. Conclusions Our findings show that SES differences in CRC incidence and mortality vary considerably across anatomical subsite and race/ethnicity. Impact Studies combining area- and individual-level SES information are warranted.

“…We also obtained the percentage of the population who were an AAPI language speaker and spoke English not well or not at all (linguistically isolated AAPI speaker; ref. 35).…”

Section: Census Tract Information and Descriptionmentioning

confidence: 99%

Disaggregating Data on Asian American and Pacific Islander Women to Provide New Insights on Potential Exposures to Hazardous Air Pollutants in California

Quach¹,

Liu²,

Nelson³

et al. 2014

Background: The Asian American and Pacific Islander (AAPI) population is heterogeneous and rapidly growing in the United States, with a high proportion concentrated in California. Although traditionally assumed to have lower rates of breast cancer than non-Hispanic white women, recent studies have suggested considerable variation in incidence by AAPI ethnic group, with rates in some exceeding those in non-Hispanic whites. The potential role of environmental toxicants has not been well explored and may provide insights into these patterns.Methods: We created an exposure potential index (EPI) score for 24 hazardous air pollutants modeled by the U.S. Environmental Protection Agency National-Scale Air Toxics Assessment considered to be mammary gland carcinogens, and compared values at the census tract level for "geographically concentrated" AAPI groups throughout the State. "Geographically concentrated" populations were defined as census tracts with at least 100 individuals from a specified racial/ethnic population as enumerated by the 2000 Census.Results: Although EPI scores differed little between census tracts with aggregated AAPI (mean EPI ¼ 0.53) and non-Hispanic white women (mean EPI ¼ 0.63), there was substantial variation between tracts for disaggregated AAPI groups, with notably higher EPI scores for tracts enumerated for Korean or Japanese women (mean EPI of 0.78 and 0.77, respectively) compared with other AAPI groups.Conclusions: Our findings underscore the importance of disaggregating data for the heterogeneous AAPI population to identify differences in potential environmental exposures across groups.Impact: Future cancer etiology studies should examine environmental exposure differences within and across groups for the diverse AAPI population. See all the articles in this CEBP Focus section, "Cancer in Asian and Pacific Islander Populations." Cancer Epidemiol Biomarkers Prev; 23(11); 2218-28. Ó2014 AACR.