County-level characteristics associated with incidence,late-stage incidence,and mortality from screenable cancers |
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| Institution: | 1. Penn State College of Medicine, Hershey, PA, USA;2. Huntsman Cancer Institute, Salt Lake City, UT, USA;3. University of Utah, Salt Lake City, UT, USA;1. Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda;2. Harvard Medical School, Boston, MA, United States;3. Moi University, Eldoret, Kenya;4. Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya;5. University of California, San Francisco, CA, United States;6. Masaka Regional Referral Hospital, Masaka, Uganda;7. Mbarara Regional Referral Hospital, Mbarara, Uganda;8. Indiana University, Indianapolis, IN, United States;1. Institute for Cancer Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany;2. Danish Cancer Society, Strandboulevarden 49, 2100, København, Denmark;1. Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA;2. Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA;3. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA;4. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA;5. Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA;1. Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230000, Anhui, China;2. Laboratory for Environmental Toxicology, Anhui Medical University, Hefei 230032, Anhui, China;1. Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Paediatric Oncology and Haematology, Germany;2. Charité-Universistätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Germany;3. Charité-Univesristätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology (iBiKE), Germany;4. St. Anna Kinderspital Vienna, Austria;5. University Hospital Hradec Králové, Czech Republic;6. University Hospital Ostrava, Czech Republic;7. University Hospital Brno, Czech Republic;8. Medical University Bialystok, Poland;9. University Hospital Motol, Prague, Czech Republic;10. Medical University Graz, Austria;11. University of Lucerne, Department of Health Sciences and Medicine, Switzerland;12. Medical University Wroclaw, Poland;13. Kepler Universitätsklinikum GmbH, Linz, Austria;14. Eastern Switzerland University of Applied Sciences, Department of Health Sciences, Institute of Applied Nursing Science, St. Gallen, Switzerland;15. Berlin Institute of Health (BIH), Berlin, Germany;1. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada;3. Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Italy;4. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy;5. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;6. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;7. Departments of Urology, Weill Cornell Medical College, New York, NY, USA;8. Department of Urology, University of Texas Southwestern, Dallas, TX, USA;9. Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic;10. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;11. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan |
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| Abstract: | BackgroundCancer screening differs by rurality and racial residential segregation, but the relationship between these county-level characteristics is understudied. Understanding this relationship and its implications for cancer outcomes could inform interventions to decrease cancer disparities.MethodsWe linked county-level information from national data sources: 2008–2012 cancer incidence, late-stage incidence, and mortality rates (for breast, cervical, and colorectal cancer) from U.S. Cancer Statistics and the National Death Index; metropolitan status from U.S. Department of Agriculture; residential segregation derived from American Community Survey; and prevalence of cancer screening from National Cancer Institute’s Small Area Estimates. We used multivariable, sparse Poisson generalized linear mixed models to assess cancer incidence, late-stage incidence, and mortality rates by county-level characteristics, controlling for density of physicians and median household income.ResultsCancer incidence, late-stage incidence, and mortality rates were 6–18% lower in metropolitan counties for breast and colorectal cancer, and 2–4% lower in more segregated counties for breast and colorectal cancer. Generally, reductions in cancer associated with residential segregation were limited to non-metropolitan counties. Cancer incidence, late-stage incidence, and mortality rates were associated with screening, with rates for corresponding cancers that were 2–9% higher in areas with more breast and colorectal screening, but 2–15% lower in areas with more cervical screening.DiscussionLower cancer burden was observed in counties that were metropolitan and more segregated. Effect modification was observed by metropolitan status and county-level residential segregation, indicating that residential segregation may impact healthcare access differently in different county types. Additional studies are needed to inform interventions to reduce county-level disparities in cancer incidence, late-stage incidence, and mortality. |
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| Keywords: | Metropolitan status Racial residential segregation Cancer screening Cancer incidence Cancer mortality |
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