Zahrieh David, Golafshar Michael A, Patel Samir H, DeWees Todd A
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Mayo Clinic, Department of Quantitative Health Sciences, 200 First St SW, Rochester, MN 55905. Email:
Prev Chronic Dis. 2021 Mar 11;18:E23. doi: 10.5888/pcd18.200468.
The incidence of breast cancer among non-Hispanic American Indian and Alaska Native (AI/AN) women varies across the United States. We applied county-level Bayesian disease mapping to quantify potential inequities in 10-year breast cancer incidence in New Mexico to better inform health equity initiatives among its non-Hispanic at-risk AI/AN population.
We used data from the Surveillance, Epidemiology, and End Results (SEER) program from 2005 through 2014 to identify new cases of breast cancer in New Mexico's 33 counties. To account for spatial variation, a county-level Area Deprivation Index, and the small area estimation problem inherent in these data, we borrowed strength globally and locally by applying Bayesian disease mapping to the counts of age-adjusted county-level breast cancer incidence. We quantified the disparity effect, as measured by the age-adjusted rate ratio, comparing the incidence of breast cancer between at-risk non-Hispanic AI/AN and non-Hispanic White women and assessed whether the ratio differed among counties.
Accounting for over-dispersion and spatial correlation among the 33 counties and a county-level Area Deprivation Index, the posterior mean of the overall age-adjusted rate ratio was 0.384 (95% credible interval, 0.253--0.546). The age-adjusted rate of breast cancer in non-Hispanic AI/AN women was 0.38 times the corresponding age-adjusted rate for non-Hispanic White women; however, a significant reduction in breast cancer incidence was observed in 16 of the 33 counties.
The application of Bayesian disease mapping to these data provided substantial evidence of an overall disparity in breast cancer incidence between at-risk non-Hispanic AI/AN and non-Hispanic White women in New Mexico, which was more marked than previously reported and limited to certain counties. Targeted statewide and county-level health-equity initiatives may lead to a reduction in these disparities.
非西班牙裔美国印第安人和阿拉斯加原住民（AI/AN）女性的乳腺癌发病率在美国各地有所不同。我们应用县级贝叶斯疾病映射法来量化新墨西哥州10年乳腺癌发病率的潜在不平等情况，以便为其非西班牙裔高危AI/AN人群的健康公平倡议提供更充分的信息。
我们使用了2005年至2014年监测、流行病学和最终结果（SEER）项目的数据，以确定新墨西哥州33个县的乳腺癌新发病例。为了考虑空间变异、县级地区剥夺指数以及这些数据中固有的小区域估计问题，我们通过将贝叶斯疾病映射应用于年龄调整后的县级乳腺癌发病率计数，在全局和局部层面借用了数据强度。我们通过年龄调整率比来量化差异效应，比较高危非西班牙裔AI/AN女性和非西班牙裔白人女性之间的乳腺癌发病率，并评估该比率在各县之间是否存在差异。
在考虑33个县之间的过度离散和空间相关性以及县级地区剥夺指数后，总体年龄调整率比的后验均值为0.384（95%可信区间，0.253 - 0.546）。非西班牙裔AI/AN女性的年龄调整后乳腺癌发病率是相应非西班牙裔白人女性年龄调整后发病率的0.38倍；然而，在33个县中的16个县观察到乳腺癌发病率显著降低。
将贝叶斯疾病映射应用于这些数据，为新墨西哥州高危非西班牙裔AI/AN女性和非西班牙裔白人女性之间乳腺癌发病率的总体差异提供了大量证据，这种差异比之前报道的更为明显，且仅限于某些县。有针对性的全州范围和县级健康公平倡议可能会减少这些差异。
