Spatial, Temporal, Social Disparities in Breast Cancer

乳腺癌的空间、时间和社会差异

• 批准号: 7869338
• 负责人: Mario Schootman
• 金额: $ 34.47万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7869338
• 关键词: Accounting; Address; American Medical Association; Area; Australia; Bayesian Method; Behavioral Risk Factor Surveillance System; Breast Cancer Detection; Cancer Etiology; Censuses; Cessation of life; Characteristics; Country; County; Data; Detection; Diagnostic Neoplasm Staging; Disease; Europe; European; Geography; Health; Health Planning; In Situ; Incidence; Interdisciplinary Study; Intervention; Iowa; Legal; Link; Locally Advanced Malignant Neoplasm; Malignant Neoplasms; Mammography; Measures; Mediating; Medical Surveillance; Modeling; Monitor; Neoplasm Metastasis; New Zealand; Outcome; Pathway interactions; Pattern; Physicians; Population; Population Density; Positive Lymph Node; Prevalence; Primary Care Physician; Recommendation; Relative (related person); Resources; SEER Program; San Francisco; Screening Result; Screening procedure; Services; Staging; Strategic Planning; Techniques; Testing; Time; United States; Variant; Vermont; Woman; advanced disease; aged; base; cost; deprivation; experience; geographic difference; health disparity; health inequalities; indexing; lymph nodes; malignant breast neoplasm; mortality; population health; prevent; programs; public health relevance; randomized trial; social; social disparities; social inequality; socioeconomics; statistics; tool; trend; tumor

DESCRIPTION (provided by applicant): Screening for breast cancer reduces mortality. Following the implementation of screening programs, European studies have shown that the incidence of early-stage and in situ breast cancers increased substantially. This was followed by a decline in the incidence of advanced-stage breast cancers, which approximated the size of the reduction in mortality rates. This pathway of effects towards mortality reduction resulting from screening would also be expected in the United States, but studies examining such reduction are currently lacking. Monitoring the effects of breast cancer screening in the United States among counties is clearly beneficial since this will facilitate local health planning and allocation of screening resources. Although screening use varies geographically, the extent to which changes over time in the effects of screening have varied among different counties in the United States is unclear. One explanation for the geographic variation in screening is that women from socioeconomically deprived areas are less likely to be screened. Because of the importance of physician recommendation to breast cancer screening and the mediating effect of primary care physician and mammography facility availability in the association between area deprivation and various health outcomes, we hypothesize that the differences in effect of breast cancer screening among counties with varying socioeconomic conditions will be mediated by the availability of primary care physicians and mammography facilities locally. In the second revision of this proposal, we will use an ecological study to: (1) Investigate the spatio-temporal variation of early stage breast cancer, advanced stage breast cancer, and breast cancer mortality at the county-level using 1988-2005 data from nine SEER programs and 200 counties; (2) Determine the association of the county-specific variation of breast cancer screening prevalence with the county-specific incidence of advanced stage breast cancer and with breast cancer mortality; (3) Determine if temporal changes in early stage breast cancer, advanced stage breast cancer, and breast cancer mortality vary by county socioeconomic conditions; and (4) Determine if the availability of primary care physicians and mammography facilities at the county level explains the temporal differences between affluent and socioeconomically deprived counties in the incidence of early stage breast cancer, advanced stage breast cancer, and breast cancer mortality. Bayesian methods will be used as part of spatio-temporal models. PUBLIC HEALTH RELEVANCE: Monitoring the effects of breast cancer screening in the United States among counties is clearly beneficial since this will facilitate local health planning and allocation of screening resources. We will use an ecological study to: (1) Investigate the spatio-temporal variation of early stage breast cancer, advanced stage breast cancer, and breast cancer mortality at the county-level using 1988-2005 data from nine SEER programs and 200 counties; (2) Determine the association of the county-specific variation of breast cancer screening prevalence with the county-specific incidence of advanced stage breast cancer and with breast cancer mortality; (3) Determine if temporal changes in early stage breast cancer, advanced stage breast cancer, and breast cancer mortality vary by county socioeconomic conditions; and (4) Determine if the availability of primary care physicians and mammography facilities at the county level explains the temporal differences between affluent and socioeconomically deprived counties in the incidence of early stage breast cancer, advanced stage breast cancer, and breast cancer mortality.

描述(申请人提供)：乳腺癌筛查可降低死亡率。随着筛查计划的实施，欧洲的研究表明，早期和原位乳腺癌的发病率大幅增加。紧随其后的是晚期乳腺癌发病率的下降，这与死亡率下降的幅度大致相同。这种通过筛查降低死亡率的途径在美国也是可以预期的，但目前缺乏对这种降低进行检验的研究。监测美国各州乳腺癌筛查的效果显然是有益的，因为这将促进当地的卫生规划和筛查资源的分配。尽管筛查的使用在地理上有所不同，但随着时间的推移，筛查效果在美国不同县之间的变化程度尚不清楚。对筛查地域差异的一种解释是，来自社会经济贫困地区的女性不太可能接受筛查。由于医生推荐对乳腺癌筛查的重要性，以及初级保健医生和乳房X光检查设施的可用性在区域剥夺与各种健康结果之间的关系中的中介作用，我们假设，不同社会经济条件的县之间乳腺癌筛查效果的差异将受到当地初级保健医生和乳房X光检查设施可用性的影响。在这项建议的第二次修订中，我们将使用生态学研究：(1)使用来自9个SEER项目和200个县的1988-2005年的数据，调查县级早期乳腺癌、晚期乳腺癌和乳腺癌死亡率的时空变化；(2)确定乳腺癌筛查流行率的县特有变异与县特有的晚期乳腺癌发病率和乳腺癌死亡率的关系；(3)确定早期乳腺癌、晚期乳腺癌和乳腺癌死亡率的时间变化是否因县的社会经济条件而异；以及(4)确定县一级初级保健医生和乳房X光检查设施的可用性是否解释了富裕县和社会经济贫困县在早期乳腺癌、晚期乳腺癌和乳腺癌死亡率方面的时间差异。贝叶斯方法将被用作时空模型的一部分。公共卫生相关性：监测美国各州乳腺癌筛查的效果显然是有益的，因为这将促进当地卫生规划和筛查资源的分配。我们将利用生态学研究：(1)使用来自9个SEER项目和200个县的1988-2005年数据，调查县级早期乳腺癌、晚期乳腺癌和乳腺癌死亡率的时空变化；(2)确定乳腺癌筛查患病率的县特有变异与县特有的晚期乳腺癌发病率和乳腺癌死亡率的关系；(3)确定早期乳腺癌、晚期乳腺癌和乳腺癌死亡率的时间变化是否因县的社会经济条件而异；以及(4)确定县一级初级保健医生和乳房X光检查设施的可用性是否解释了富裕县和社会经济贫困县在早期乳腺癌、晚期乳腺癌和乳腺癌死亡率方面的时间差异。

项目成果

Efficient mapping and geographic disparities in breast cancer mortality at the county-level by race and age in the U.S.

• DOI: 10.1016/j.sste.2013.03.002
• 发表时间: 2013-06
• 期刊: Spatial and spatio-temporal epidemiology
• 影响因子: 3.4
• 作者: Chien LC;Yu HL;Schootman M
• 通讯作者: Schootman M

Comparing GIS-based measures in access to mammography and their validity in predicting neighborhood risk of late-stage breast cancer.

比较基于 GIS 的乳房 X 光检查方法及其在预测邻近晚期乳腺癌风险方面的有效性。

• DOI: 10.1371/journal.pone.0043000
• 发表时间: 2012
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Lian M;Struthers J;Schootman M
• 通讯作者: Schootman M

Temporal trends in area socioeconomic disparities in breast-cancer incidence and mortality, 1988-2005.

• DOI: 10.1007/s10549-009-0729-y
• 发表时间: 2010-07
• 期刊: BREAST CANCER RESEARCH AND TREATMENT
• 影响因子: 3.8
• 作者: Schootman, Mario;Lian, Min;Deshpande, Anjali D.;Baker, Elizabeth A.;Pruitt, Sandi L.;Aft, Rebecca;Jeffe, Donna B.
• 通讯作者: Jeffe, Donna B.

Influence of primary care physician availability and socioeconomic deprivation on breast cancer from 1988 to 2008: a spatio-temporal analysis.

• DOI: 10.1371/journal.pone.0035737
• 发表时间: 2012
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Chien LC;Deshpande AD;Jeffe DB;Schootman M
• 通讯作者: Schootman M