Huang Bin, Dignan Mark, Han Daikwon, Johnson Owen
Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA.
J Rural Health. 2009 Fall;25(4):366-71. doi: 10.1111/j.1748-0361.2009.00245.x.
National and regional data indicate that breast cancer early detection is low in Kentucky, especially rural regions, perhaps because access to mammography services can be problematic.
This study examined the distance between residences of women diagnosed with breast cancer and the nearest mammography facility, as a risk factor for advanced stage diagnosis in rural populations.
1999-2003 Kentucky Cancer Registry data were used for this study. A total of 12,322 women, aged 40 and older at diagnosis, with no previous history of cancer, and with known cancer stage were included. Travel distance was obtained using a geographic information system (GIS). Hierarchical logistic regression models were used to analyze the relationship between travel distance and advanced stage diagnosis.
Advanced diagnoses had longer average travel distances than early stage diagnoses (P < 0.01). After adjusting for age, race, insurance, and education at census tract level, the odds of advanced diagnosis were significantly greater for women residing over 15 miles from a facility, compared to those living within 5 miles (adjusted OR = 1.50, 95% CI = 1.25-1.80).
Although socioeconomic status, race, and age may help explain advanced diagnoses, longer travel distance also adversely affects early detection for rural populations. Accurate measurement of spatial accessibility indicators, such as travel distance, facilitates identification of at-risk groups so that interventions can be developed to reduce this disease.
国家和地区数据显示，肯塔基州（尤其是农村地区）的乳腺癌早期检测率较低，这可能是因为获得乳房X光检查服务存在问题。
本研究调查了被诊断为乳腺癌的女性住所与最近的乳房X光检查机构之间的距离，将其作为农村人口晚期诊断的一个风险因素。
本研究使用了1999 - 2003年肯塔基州癌症登记数据。纳入了总共12322名女性，她们在诊断时年龄在40岁及以上，无癌症病史且癌症分期已知。使用地理信息系统（GIS）获取出行距离。采用分层逻辑回归模型分析出行距离与晚期诊断之间的关系。
晚期诊断的平均出行距离比早期诊断更长（P < 0.01）。在按普查区层面的年龄、种族、保险和教育程度进行调整后，居住在距离机构超过15英里的女性晚期诊断的几率显著高于居住在5英里以内的女性（调整后的比值比 = 1.50，95%置信区间 = 1.25 - 1.80）。
尽管社会经济地位、种族和年龄可能有助于解释晚期诊断，但更长的出行距离也对农村人口的早期检测产生不利影响。准确测量空间可达性指标，如出行距离，有助于识别高危人群，从而制定干预措施以减少这种疾病。
