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J Rural Health. 2017 Apr;33(2):146-157. doi: 10.1111/jrh.12179. Epub 2016 Mar 14.

Geographic Variations of Colorectal and Breast Cancer Late-Stage Diagnosis and the Effects of Neighborhood-Level Factors.

Author information

1
Department of Geography, South Dakota State University, Brookings, South Dakota.
2
Geospatial Sciences Center of Excellence, South Dakota State University, Brookings, South Dakota.

Abstract

PURPOSE:

The purpose of this study was to examine the geographic variations of late-stage diagnosis in colorectal cancer (CRC) and breast cancer as well as to investigate the effects of 3 neighborhood-level factors-socioeconomic deprivation, urban/rural residence, and spatial accessibility to health care-on the late-stage risks.

METHODS:

This study used population-based South Dakota cancer registry data from 2001 to 2012. A total of 4,878 CRC cases and 6,418 breast cancer cases were included in the analyses. Two-level logistic regression models were used to analyze the risk of late-stage CRC and breast cancer.

FINDINGS:

For CRC, there was a small geographic variation across census tracts in late-stage diagnosis, and residing in isolated small rural areas was significantly associated with late-stage risk. However, this association became nonsignificant after adjusting for census-tract level socioeconomic deprivation. Socioeconomic deprivation was an independent predictor of CRC late-stage risk, and it explained the elevated risk among American Indians. No relationship was found between spatial accessibility and CRC late-stage risk. For breast cancer, no geographic variation in the late-stage diagnosis was observed across census tracts, and none of the 3 neighborhood-level factors was significantly associated with late-stage risk.

CONCLUSIONS:

Results suggested that socioeconomic deprivation, rather than spatial accessibility, contributed to CRC late-stage risks in South Dakota as a rural state. CRC intervention programs could be developed to target isolated small rural areas, socioeconomically disadvantaged areas, as well as American Indians residing in these areas.

KEYWORDS:

breast cancer; colorectal cancer; geographic access to care; health disparities; rural

PMID:
26987939
DOI:
10.1111/jrh.12179
[Indexed for MEDLINE]

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