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Breast Cancer Screening, Area Deprivation, and Later‐Stage Breast Cancer in Appalachia: Does Geography Matter?
Author(s) -
Anderson Roger T.,
Yang TseChang,
Matthews Stephen A.,
Camacho Fabian,
Kern Teresa,
Mackley Heath B.,
Kimmick Gretchen,
Louis Christopher,
Lengerich Eugene,
Yao Nengliang
Publication year - 2014
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12108
Subject(s) - appalachia , demography , breast cancer , breast cancer screening , medicine , population , cancer , census , mammography , cancer registry , geography , gerontology , environmental health , biology , paleontology , sociology
Objective To model the relationship of an area‐based measure of a breast cancer screening and geographic area deprivation on the incidence of later stage breast cancer ( LSBC ) across a diverse region of A ppalachia. Data Source Central cancer registry data (2006–2008) from three A ppalachian states were linked to M edicare claims and census data. Study Design Exploratory spatial analysis preceded the statistical model based on negative binomial regression to model predictors and effect modification by geographic subregions. Principal Findings Exploratory spatial analysis revealed geographically varying effects of area deprivation and screening on LSBC . In the negative binomial regression model, predictors of LSBC included receipt of screening, area deprivation, supply of mammography centers, and female population aged >75 years. The most deprived counties had a 3.31 times greater rate of LSBC compared to the least deprived. Effect of screening on LSBC was significantly stronger in northern Appalachia than elsewhere in the study region, found mostly for high‐population counties. Conclusions Breast cancer screening and area deprivation are strongly associated with disparity in LBSC in A ppalachia. The presence of geographically varying predictors of later stage tumors in A ppalachia suggests the importance of place‐based health care access and risk.