Department of Geosciences, Core Faculty in Partnership for Urban Health Research, Institute of Public Health, 33 Gilmer Street, Georgia State University, Atlanta, GA 30303, USA.
Health Place. 2010 Sep;16(5):1038-52. doi: 10.1016/j.healthplace.2010.06.012. Epub 2010 Jul 13.
This study evaluates the role of black residential segregation and spatial access to health care in explaining the variation in late-stage diagnosis of breast cancer in metropolitan Detroit. Data pertaining to female breast cancer from 1998 to 2002 are obtained from the Michigan Cancer Surveillance Program. An isolation index is used to assess black segregation. The 2-step floating catchment area approach integrated with a Gaussian function is used to estimate the health care access. While socioeconomic factors at ZIP code level are controlled, ordinary least squares and spatial lag models are used to explore the association between the rates of late-stage diagnosis and segregation and health care access. Results suggest that living in areas with greater black segregation and poorer mammography access significantly increases the risk of late diagnosis of breast cancer. Disadvantaged populations including those with low socioeconomic status or sociocultural barriers tend to experience high rates of late diagnosis. Findings emphasize the need for heightened screening, surveillance, and intervention programs in these areas.
本研究评估了黑人居住隔离和获得医疗保健的空间机会在解释底特律大都市区乳腺癌晚期诊断差异方面的作用。1998 年至 2002 年与女性乳腺癌相关的数据来自密歇根癌症监测计划。采用隔离指数评估黑人隔离程度。两步浮动捕获区方法与高斯函数相结合，用于估计医疗保健的可及性。在控制邮政编码级别的社会经济因素的同时，采用普通最小二乘法和空间滞后模型来探讨晚期诊断率与隔离和医疗保健可及性之间的关系。结果表明，生活在黑人隔离程度更高、乳房 X 光检查机会更差的地区，显著增加了乳腺癌晚期诊断的风险。弱势群体，包括社会经济地位较低或存在社会文化障碍的人群，往往会出现晚期诊断率较高的情况。研究结果强调了在这些地区需要加强筛查、监测和干预计划。
