Determinants of delayed detection of cancers in Texas Counties in the United States of America

International Journal for Equity in Health

Billy U Philips⁴  Conrad P Lyford³  Kristopher A Hargrave¹  Eric Belasco²  Gordon Gong¹ 

[1] F. Marie Hall Institute for Rural Community Health, Texas Tech University Health Science Center, Lubbock, TX 79430, USA;Department of Agricultural Economics and Economics, Montana State University, Bozeman, MT 59717-2920, USA;Department of Agricultural and Applied Economics, Texas Tech University, Lubbock, TX 79409, USA;Department of Family and Community Medicine, F. Marie Hall Institute for Rural and Community Health, Texas Tech University Health Science Center, Suite 2B440 - 3601 4th Street MS 6232, Lubbock, TX 79430-6232, USA

关键词: Wellbeing index;    Deprivation;    Socioeconomic;    Cancer;    Early detection;   

Others  :  829072
DOI  :  10.1186/1475-9276-11-29

 received in 2012-02-23, accepted in 2012-04-20,  发布年份 2012

【 摘 要 】

Introduction

Previous studies have shown that delayed detection of several cancers is related to socioeconomic deprivation as measured by the Wellbeing Index (WI) in Texas, the United States of America (USA). The current study investigates whether delayed cancer detection is related to lack of health insurance, physician shortage and higher percentages of Hispanics rather than WI per se since these factors are directly related to delayed cancer detection and may confound WI.

Methods

Cancer data and potential determinants of delayed cancer detection are derived from Texas Cancer Registry, Texas State Data Center, and Texas Department of State Health Services and U.S. Census Bureau. Texas cancer data from 1997 to 2003 are aggregated to calculate age-adjusted late- and early-stage cancer detection rates. The WI for each county is computed using data from the USA Census 2000. A weighted Tobit regression model is used to account for population size and censoring. The percentage of late-stage cancer cases is the dependent variable while independent variables include WI and the aforementioned potential confounders.

Results

Delayed detection of breast, lung, colorectal and female genital cancers is associated with higher percentage of uninsured residents (p < 0.05). Delayed detection is also associated with physician shortage and lower percentages of Hispanics for certain cancers ceteris paribus ( p < 0.05). The percentage of late-stage cases is positively correlated with WI for lung, and prostate cancers after adjusting for confounders ( p < 0.05).

Conclusions

The percentages of uninsured and Hispanic residents as well as physician supply are determinants of delayed detection for several cancers independently of WI, and vice versa. Identification of these determinants provides the evidence-base critical for decision makers to address specific issues for promoting early detection in effective cancer control.

【 授权许可】

   
2012 Gong et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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