Wang Fahui, McLafferty Sara, Escamilla Veronica, Luo Lan
Louisiana State University.
Prof Geogr. 2008 Feb;60(1):54-69. doi: 10.1080/00330120701724087.
The variations of breast cancer mortality rates from place to place reflect both underlying differences in breast cancer prevalence and differences in diagnosis and treatment that affect the risk of death. This article examines the role of access to health care in explaining the variation of late-stage diagnosis of breast cancer. We use cancer registry data for the state of Illinois by zip code to investigate spatial variation in late diagnosis. Geographic information systems and spatial analysis methods are used to create detailed measures of spatial access to health care such as convenience of visiting primary care physicians and travel time from the nearest mammography facility. The effects of spatial access, in combination with the influences of socioeconomic factors, on late-stage breast cancer diagnosis are assessed using statistical methods. The results suggest that for breast cancer, poor geographical access to primary health care significantly increases the risk of late diagnosis for persons living outside the city of Chicago. Disadvantaged population groups including those with low income and racial and ethnic minorities tend to experience high rates of late diagnosis. In Illinois, poor spatial access to primary health care is more strongly associated with late diagnosis than is spatial access to mammography. This suggests the importance of primary care physicians as gatekeepers in early breast cancer detection.
各地乳腺癌死亡率的差异既反映了乳腺癌患病率的潜在差异，也反映了影响死亡风险的诊断和治疗方面的差异。本文探讨了获得医疗保健服务在解释乳腺癌晚期诊断差异方面所起的作用。我们使用伊利诺伊州按邮政编码划分的癌症登记数据来调查晚期诊断的空间差异。利用地理信息系统和空间分析方法来创建详细的空间医疗保健服务可及性指标，例如拜访初级保健医生的便利性以及从最近的乳房X光检查机构的出行时间。使用统计方法评估空间可及性与社会经济因素的影响对晚期乳腺癌诊断的综合作用。结果表明，对于乳腺癌而言，初级卫生保健的地理可及性差会显著增加居住在芝加哥市以外地区的人晚期诊断的风险。包括低收入人群以及少数种族和族裔群体在内的弱势群体往往晚期诊断率较高。在伊利诺伊州，初级卫生保健的空间可及性差与晚期诊断的关联比乳房X光检查的空间可及性与晚期诊断的关联更为紧密。这表明初级保健医生作为早期乳腺癌检测把关人的重要性。
