Lin Yan, Zhan F Benjamin
From the Texas Center for Geographic Information Science, Department of Geography, Texas State University, San Marcos.
South Med J. 2014 May;107(5):281-8. doi: 10.1097/SMJ.0000000000000100.
To examine how racial/ethnic disparities of cervical cancer mortality vary geographically and to identify factors contributing to the variation.
Using the population-weighted risk difference, the authors investigated geographic patterns of racial/ethnic disparities in cervical cancer mortality in Texas based on data from 1995 to 2008 georeferenced at the census tract level. In addition, we considered the impact of seven factors--stage at diagnosis, spatial access to health care, and five factors that were created from available demographic data: socioeconomic status (SES), the sociodemographic factor, the percentage of African Americans, the health insurance factor, and the behavioral factor--on racial/ethnic disparities in the analysis using multivariate logistic regression.
SES, the sociodemographic factor, the percentage of African Americans, and racial/ethnic disparities in late-stage diagnosis in a census tract were independent predictors of a census tract's displaying significant racial/ethnic disparities in cervical cancer mortality. Compared with a census tract with the highest SES, a census tract with the lowest SES was more likely to have higher mortality rates in African Americans (odds ratio 4.19, confidence interval 2.18-8.07) or Hispanics (odds ratio 8.15, confidence interval 5.27-12.61) than non-Hispanic whites after adjusting for covariates. Health insurance expenditures also influenced racial/ethnic disparities in mortality, although this effect was attenuated after adjusting for covariates. Neither our calculated behavioral factor nor spatial analysis of access to health care explained racial/ethnic gaps in mortality.
Findings from this study could allow cervical cancer intervention programs to more clearly identify areas that would reduce disparities in cervical cancer outcomes.
研究宫颈癌死亡率的种族/民族差异在地理上如何变化，并确定导致这种差异的因素。
作者利用人口加权风险差异，基于1995年至2008年在普查区层面进行地理定位的数据，调查了得克萨斯州宫颈癌死亡率的种族/民族差异的地理模式。此外，在多变量逻辑回归分析中，我们考虑了七个因素的影响——诊断阶段、获得医疗保健的空间便利性，以及从现有人口数据中得出的五个因素：社会经济地位（SES）、社会人口因素、非裔美国人的比例、医疗保险因素和行为因素——对种族/民族差异的影响。
社会经济地位、社会人口因素、非裔美国人的比例以及普查区晚期诊断中的种族/民族差异是普查区在宫颈癌死亡率方面表现出显著种族/民族差异的独立预测因素。与社会经济地位最高的普查区相比，在调整协变量后，社会经济地位最低的普查区的非裔美国人（优势比4.19，置信区间2.18 - 8.07）或西班牙裔（优势比8.15，置信区间5.27 - 12.61）的死亡率比非西班牙裔白人更高。医疗保险支出也影响了死亡率方面的种族/民族差异，尽管在调整协变量后这种影响有所减弱。我们计算出的行为因素和获得医疗保健的空间分析都无法解释死亡率方面的种族/民族差距。
本研究的结果可使宫颈癌干预项目更明确地确定能够减少宫颈癌结局差异的地区。
