An ecological approach to monitor geographic disparities in cancer outcomes

Area-level indices are widely used to assess the impact of socio-environmental characteristics on cancer outcomes. While area-level measures of socioeconomic status (SES) have been previously used in cancer settings, fewer studies have focused on evaluating the impact of area-level health services s...

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Bibliographic Details
Published in:PloS one Vol. 14; no. 6; p. e0218712
Main Authors: Jayasekera, Jinani, Onukwugha, Eberechukwu, Cadham, Christopher, Harrington, Donna, Tom, Sarah, Pradel, Francoise, Naslund, Michael
Format: Journal Article
Language:English
Published: United States Public Library of Science 21.06.2019
Public Library of Science (PLoS)
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Analysis
Biology and Life Sciences
Breast cancer
Cancer
Cancer diagnosis
Cancer research
Census of Population
Censuses
Clinical outcomes
Counties
Diagnosis
Ecological studies
Educational attainment
Employment
Environmental aspects
Environmental impact
Epidemiology
Female
Geography
Health
Health care
Health care facilities
Health services
Healthcare Disparities - statistics & numerical data
Humans
Incidence
Indexes
Lung cancer
Lung diseases
Male
Medical diagnosis
Medical personnel
Medical research
Medicine
Medicine and Health Sciences
Methods
Middle Aged
Neoplasms - diagnosis
Neoplasms - economics
Neoplasms - epidemiology
Outcome Assessment, Health Care - methods
Patient outcomes
People and Places
Pharmacy
Poverty
Prognosis
Prostate
Prostate cancer
Race
Researchers
Scholarships & fellowships
SEER Program
Social class
Social Environment
Social Sciences
Social work
Socioeconomic Factors
Socioeconomic status
Socioeconomics
Surveillance
United States - epidemiology
Young Adult
United States
New York
United States > US
Baltimore Maryland
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary:Area-level indices are widely used to assess the impact of socio-environmental characteristics on cancer outcomes. While area-level measures of socioeconomic status (SES) have been previously used in cancer settings, fewer studies have focused on evaluating the impact of area-level health services supply (HSS) characteristics on cancer outcomes. Moreover, there is significant variation in the methods and constructs used to create area-level indices. In this study, we introduced a psychometrically-induced, reproducible approach to develop area-level HSS and SES indices. We assessed the utility of these indices in detecting the effects of area-level characteristics on prostate, breast, and lung cancer incidence and stage at diagnosis in the US. The information on county-level SES and HSS characteristics were extracted from US Census, County Business Patterns data and Area Health Resource Files. The Surveillance, Epidemiology, and End Results database was used to identify individuals diagnosed with cancer from 2010 to 2012. SES and HSS indices were developed and linked to 3-year age-adjusted cancer incidence rates. SES and HSS indices empirically summarized the level of employment, education, poverty and income, and the availability of health care facilities and health professionals within counties. SES and HSS models demonstrated good fit (TLI = 0.98 and 0.96, respectively) and internal consistency (alpha = 0.85 and 0.95, respectively). Increasing SES and HSS were associated with increasing prostate and breast cancer and decreasing lung cancer incidence rates. The results varied by stage at diagnosis and race. Composite county-level measures of SES and HSS were effective in ranking counties and detecting gradients in cancer incidence and stage at diagnosis. Thus, these measures provide valuable tools for monitoring geographic disparities in cancer outcomes.
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Competing Interests: Sarah E. Tom, is supported by National Institute on Aging grant K01AG050723. Eberechukwu Onukwugha, has received grant funding from Bayer Healthcare Pharmaceuticals mgen, IMS Health, Johnson & Johnson, Janssen Analytics and Pfizer, Inc. as well as consulting fees from Novo Nordisk.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0218712