Texas Center for Geographic Information Science, Department of Geography, Texas State University-San Marcos, Texas 78666, USA.
Womens Health Issues. 2012 May-Jun;22(3):e267-76. doi: 10.1016/j.whi.2011.11.007. Epub 2012 Jan 21.
This study evaluated the risk factors associated with racial disparities in female breast cancer mortality for African-American and Hispanic women at the census tract level in Texas from 1995 to 2005.
Data on female breast cancer cases were obtained from the Texas Cancer Registry. Socioeconomic and demographic data were collected from Census 2000. Network distance and driving times to mammography facilities were estimated using Geographic Information System techniques. Demographic, poverty and spatial accessibility factors were constructed using principal component analysis. Logistic regression models were developed to predict the census tracts with significant racial disparities in breast cancer mortality based on racial disparities in late-stage diagnosis and structured factors from the principal component analysis.
Late-stage diagnosis, poverty factors, and demographic factors were found to be significant predictors of a census tract showing significant racial disparities in breast cancer mortality. Census tracts with higher poverty status were more likely to display significant racial disparities in breast cancer mortality for both African Americans (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.95-3.04) and Hispanics (OR, 5.30; 95% CI, 4.26-6.59). Spatial accessibility was not a consistent predictor of racial disparities in breast cancer mortality for African-American and Hispanic women.
Physical access to mammography facilities does not necessarily reflect a greater utilization of mammogram screening, possibly owing to financial constraints. Therefore, a metric measuring access to health care facilities is needed to capture all aspects of access to preventive care. Despite easier physical access to mammography facilities in metropolitan areas, great resources and efforts should also be devoted to these areas where racial disparities in breast cancer mortality are often found.
本研究评估了 1995 年至 2005 年德克萨斯州按普查区划分的非裔美国人和西班牙裔女性乳腺癌死亡率的种族差异的相关风险因素。
从德克萨斯癌症登记处获取女性乳腺癌病例数据。从 2000 年人口普查中收集社会经济和人口统计数据。使用地理信息系统技术估计到乳房 X 光摄影设施的网络距离和行车时间。使用主成分分析构建人口统计、贫困和空间可达性因素。开发逻辑回归模型，根据晚期诊断的种族差异和主成分分析中的结构因素，预测在乳腺癌死亡率方面存在显著种族差异的普查区。
晚期诊断、贫困因素和人口统计因素是非裔美国人和西班牙裔女性乳腺癌死亡率方面存在显著种族差异的普查区的显著预测因素。贫困程度较高的普查区更有可能显示非裔美国人（比值比 [OR]，2.43；95%置信区间 [CI]，1.95-3.04）和西班牙裔（OR，5.30；95% CI，4.26-6.59）乳腺癌死亡率方面存在显著种族差异。空间可达性不是非裔美国人和西班牙裔女性乳腺癌死亡率种族差异的一致预测因素。
获得乳房 X 光摄影设施的物理途径并不一定反映出更多的乳房 X 光筛查利用率，这可能是由于经济限制所致。因此，需要一种衡量医疗保健设施可达性的指标来捕捉获得预防保健的所有方面。尽管大都市地区获得乳房 X 光摄影设施的物理途径更容易，但也应将大量资源和努力投入到这些经常发现乳腺癌死亡率存在种族差异的地区。
