Late-stage breast cancer diagnosis and health care access in illinois
Late-stage breast cancer diagnosis and health care access in illinois
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DOI：
10.1080/00330120701724087
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发表时间：
2008-02-01
影响因子：
1.8
通讯作者：
Luo, Lan
中科院分区：
文献类型：
--
作者：
Wang, Fahui;McLafferty, Sara;Luo, Lan
各地乳腺癌死亡率的差异反映了乳腺癌发病率的根本差异以及影响死亡风险的诊断和治疗差异。本文探讨了获得医疗保健在解释乳腺癌晚期诊断的变化中的作用。我们使用伊利诺伊州邮政编码的癌症登记数据来研究晚期诊断的空间差异。地理信息系统和空间分析方法被用来创建详细的措施，如访问初级保健医生的便利性和距离最近的乳房X光检查设施的旅行时间的空间获得保健。空间访问的影响，结合社会经济因素的影响，对晚期乳腺癌诊断的评估使用统计方法。研究结果表明，对于乳腺癌，地理条件差的初级卫生保健显着增加了生活在芝加哥以外的人的晚期诊断的风险。包括低收入和少数种族和族裔在内的离散人群往往有很高的迟发诊断率。在伊利诺伊州，初级卫生保健的空间获取能力差与晚期诊断的相关性比乳房X光检查的空间获取能力更强。这表明初级保健医生在早期乳腺癌检测中作为守门人的重要性。
The variations of breast cancer mortality rates from place to place reflect both underlying differences in breast cancer prevalence and differences in diagnosis and treatment that affect the risk of death. This article examines the role of access to health care in explaining the variation of late-stage diagnosis of breast cancer. We use cancer registry data for the state of Illinois by zip code to investigate spatial variation in late diagnosis. Geographic information systems and spatial analysis methods are used to create detailed measures of spatial access to health care such as convenience of visiting primary care physicians and travel time from the nearest mammography facility. The effects of spatial access, in combination with the influences of socioeconomic factors, on late-stage breast cancer diagnosis are assessed using statistical methods. The results suggest that for breast cancer, poor geographical access to primary health care significantly increases the risk of late diagnosis for persons living outside the city of Chicago. Disadvantaged population groups including those with low income and racial and ethnic minorities tend to experience high rates of late diagnosis. In Illinois, poor spatial access to primary health care is more strongly associated with late diagnosis than is spatial access to mammography. This suggests the importance of primary care physicians as gatekeepers in early breast cancer detection.