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Cancer Causes Control. 2018 Jun 19. doi: 10.1007/s10552-018-1051-y. [Epub ahead of print]

Mapping hot spots of breast cancer mortality in the United States: place matters for Blacks and Hispanics.

Author information

1
Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA. jxmoore@wustl.edu.
2
Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA. jxmoore@wustl.edu.
3
Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, St Louis, MO, USA. jxmoore@wustl.edu.
4
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S Taylor Avenue, TAB 2nd Floor Suite East, 7E, Saint Louis, MO, 63110-1093, USA. jxmoore@wustl.edu.
5
Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
6
Department of Biology, University of Alabama at Birmingham, Birmingham, AL, USA.
7
Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, St Louis, MO, USA.
8
Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
9
Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA.
10
Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
11
Department of Epidemiology, University of Kentucky, Lexington, KY, USA.

Abstract

PURPOSE:

The goals of this study were to identify geographic and racial/ethnic variation in breast cancer mortality, and evaluate whether observed geographic differences are explained by county-level characteristics.

METHODS:

We analyzed data on breast cancer deaths among women in 3,108 contiguous United States (US) counties from years 2000 through 2015. We applied novel geospatial methods and identified hot spot counties based on breast cancer mortality rates. We assessed differences in county-level characteristics between hot spot and other counties using Wilcoxon rank-sum test and Spearman correlation, and stratified all analysis by race/ethnicity.

RESULTS:

Among all women, 80 of 3,108 (2.57%) contiguous US counties were deemed hot spots for breast cancer mortality with the majority located in the southern region of the US (72.50%, p value < 0.001). In race/ethnicity-specific analyses, 119 (3.83%) hot spot counties were identified for NH-Black women, with the majority being located in southern states (98.32%, p value < 0.001). Among Hispanic women, there were 83 (2.67%) hot spot counties and the majority was located in the southwest region of the US (southern = 61.45%, western = 33.73%, p value < 0.001). We did not observe definitive geographic patterns in breast cancer mortality for NH-White women. Hot spot counties were more likely to have residents with lower education, lower household income, higher unemployment rates, higher uninsured population, and higher proportion indicating cost as a barrier to medical care.

CONCLUSIONS:

We observed geographic and racial/ethnic disparities in breast cancer mortality: NH-Black and Hispanic breast cancer deaths were more concentrated in southern, lower SES counties.

KEYWORDS:

Breast cancer; Geospatial analysis; Health disparities; Socioeconomic factors

PMID:
29922896
DOI:
10.1007/s10552-018-1051-y

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