Predicting Late-stage Breast Cancer Diagnosis and Receipt of Adjuvant Therapy: Applying Current Spatial Access to Care Methods in Appalachia.
Predicting Late-stage Breast Cancer Diagnosis and Receipt of Adjuvant Therapy: Applying Current Spatial Access to Care Methods in Appalachia.
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DOI：
10.1097/mlr.0000000000000432
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发表时间：
2015-11
期刊：
影响因子：
3
通讯作者：
Balkrishnan R
中科院分区：
文献类型：
--
作者：
Donohoe J;Marshall V;Tan X;Camacho FT;Anderson R;Balkrishnan R
两步浮动集水区（2SFCA）方法从未用于研究阿巴拉契亚地区的癌症差异。首先，我们比较了2SFCA方法与传统方法的关系。然后，我们研究了进入乳房x光检查中心和初级保健对晚期乳腺癌诊断和接受辅助激素治疗的影响。来自宾夕法尼亚州、俄亥俄州、肯塔基州和北卡罗来纳州的癌症登记处与医疗保险数据相关联，以确定2006-2008年阿巴拉契亚地区女性乳腺癌诊断的阶段。有资格接受辅助治疗的妇女有I、II或III期诊断；乳房切除术或保乳手术；以及激素受体阳性的乳腺癌。使用地理加权回归（GWR）来探索人口统计和空间访问预测变量的非平稳性。在15,299名被诊断患有乳腺癌的妇女中，超过21%的人诊断为晚期（III-IV期）。预测因素包括诊断时年龄（比值比[OR]， 0.86; P < 0.001）、保险状况（OR, 1.32; P < 0.001）、县初级保健与人口比率（OR, 0.95; P < 0.001）和初级保健2SFCA评分（OR, 0.96; P = 0.006）。只有46.9%的符合条件的妇女接受了辅助激素治疗，预测因素包括合并症状况（OR, 1.18; P = 0.047）、县经济状况（OR, 1.32; P = 0.006）和乳房x光检查中心2SFCA评分（OR, 1.12; P = 0.021）。方法学上，2SFCA方法提供了最大的预测有效性的访问措施检查。实质上，晚期乳腺癌的诊断率和辅助激素治疗在阿巴拉契亚地区是不合格的。
The two-step floating catchment area (2SFCA) method of measuring access to care has never been used to study cancer disparities in Appalachia. First, we evaluated the 2SFCA method in relation to traditional methods. We then examined the impact of access to mammography centers and primary care on late stage breast cancer diagnosis and receipt of adjuvant hormonal therapy. Cancer registries from Pennsylvania, Ohio, Kentucky, and North Carolina were linked with Medicare data to identify the stage of breast cancer diagnosis for Appalachia women diagnosed between 2006–2008. Women eligible for adjuvant therapy had stage I, II, or III diagnosis; mastectomy or breast conserving surgery; and hormone-receptor positive breast cancers. Geographically weighted regression (GWR) was used to explore non-stationarity in the demographic and spatial access predictor variables. Over 21% of 15,299 women diagnosed with breast cancer had late-stage (stages III–IV) diagnosis. Predictors included age at diagnosis (odds ratio [OR], 0.86; P < 0.001), insurance status (OR, 1.32; P < 0.001), county primary care to population ratio (OR, 0.95; P < 0.001), and primary care 2SFCA score (OR, 0.96; P = 0.006). Only 46.9% of eligible women received adjuvant hormonal therapy, and predictors included comorbidity status (OR, 1.18; P = 0.047), county economic status (OR, 1.32; P = 0.006), and mammography center 2SFCA scores (OR, 1.12; P = 0.021). Methodologically, the 2SFCA method offered the greatest predictive validity of the access measures examined. Substantively, rates of late stage breast cancer diagnosis and adjuvant hormonal therapy are substandard in Appalachia.