Black-White Disparities in Breast Cancer Outcomes in the Surveillance Epidemiology and End Results (SEER) of the United States and in Michigan: The Role of Neighborhood and Individual Healthcare Access.

Epidemiology;Racial Disparities;Breast Cancer Outcomes;Healthcare Access;Public Health;Health Sciences;Epidemiological Science

Akinyemiju, Omotomilayo F.Schwartz, Kendra L. ;

University of Michigan

关键词: Epidemiology;    Racial Disparities;    Breast Cancer Outcomes;    Healthcare Access;    Public Health;    Health Sciences;    Epidemiological Science;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/93861/tomiaki_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

Breast cancer incidence and mortality rates have declined in the US for the past 10-15 years, but the decline has been larger in white women compared with blacks. The causes of racial disparities in breast cancer outcomes have been attributed to biological factors, socio-economic status (SES), and healthcare access (HCA). However, research suggests that when examining social determinants of diseases, it is important to consider both individual and neighborhood level factors. This area of research has received little attention in explaining racial disparities in breast cancer. Therefore, this dissertation aimed to examine the impact of SES and HCA at the individual and neighborhood levels on racial disparities in breast cancer screening, mortality, and survival. First, the impact of SES and HCA at the individual and county levels on breast cancer screening rates among blacks and whites in Michigan was examined using data from the Special Cancer Behavioral Risk Factor Survey.The most important predictors of adequate breast cancer screening were having health insurance and a usual healthcare provider. Second, the impact of individual SES and HCA on breast cancer survival among black and white women was assessed using the linked dataset of U.S. Surveillance, Epidemiology, and End Results (SEER) and National Longitudinal Mortality Study (NLMS). Initial racial differences in survival disappeared after adjusting for socio-demographic and treatment variables. Finally, the annual age-adjusted breast cancer mortality rate and percent late stage trends in Michigan from 1992-2009 by zip-code SES and HCA was examined using cancer surveillance data from the Michigan Department of Community Health.Black women in Michigan had consistently higher mortality rates and late stage of presentation compared with white women, regardless of neighborhood SES and HCA.White women had increasing rates of late stage presentation, likely due to lower screening rates resulting from lack of health insurance given the high unemployment rates in Michigan. These findings suggest that increasing access to timely screening and treatment among uninsured populations may improve breast cancer outcomes for all population groups regardless of race and socio-economic status.