The joint effects of census tract poverty and geographic access on late-stage breast cancer diagnosis in 10 US States

Kevin A. Henry, Recinda Sherman, Steve Farber, Myles Cockburn, Daniel W. Goldberg, Antoinette M. Stroup

Research output: Contribution to journalArticlepeer-review

49 Scopus citations

Abstract

This study evaluated independent and joint effects of census tract (CT) poverty and geographic access to mammography on stage at diagnosis for breast cancer. The study included 161,619 women 40+ years old diagnosed with breast cancer between 2004 -2006 in ten participating US states. Multilevel logistic regression was used to estimate the odds of late-stage breast cancer diagnosis for the entire study population and by state. Poverty was independently associated with late-stage in the overall population (poverty rates >20% OR=1.30, 95% CI=1.26- 1.35) and for 9 of the 10 states. Geographic access was not associated with late-stage diagnosis after adjusting for CT poverty. State-specific analysis provided little evidence that geographic access was associated with breast cancer stage at diagnosis, and after adjusting for poverty, geographic access mattered in only 1 state. Overall, compared to women with private insurance, the adjusted odds ratios for late stage at diagnosis among women with either no insurance, Medicaid, or Medicare were 1.80 (95% CI = 1.65, 1.96), 1.75 (95% CI = 1.68, 1.84), and 1.05 (95% CI 1.01, 1.08), respectively. Although geographic access to mammography was not a significant predictor of late-stage breast cancer diagnosis, women in high poverty areas or uninsured are at greatest risk of being diagnosed with late-stage breast cancer regardless of geographic location and may benefit from targeted interventions.

Original languageEnglish
Pages (from-to)110-121
Number of pages12
JournalHealth and Place
Volume21
DOIs
StatePublished - May 2013

Keywords

  • Access to care
  • Breast cancer
  • Cancer stage at diagnosis
  • Cancer survival
  • Urban/rural

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