School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey, USA.
Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Health Serv Res. 2023 Aug;58 Suppl 2(Suppl 2):152-164. doi: 10.1111/1475-6773.14182. Epub 2023 May 19.
To examine geospatial patterns of cancer care utilization across diverse populations in New Jersey-a state where most residents live in urban areas.
DATA SOURCES/STUDY SETTING: We used data from the New Jersey State Cancer Registry from 2012 to 2014.
We examined the location of cancer treatment among patients 20-65 years of age diagnosed with breast, colorectal, or invasive cervical cancer and investigated differences in geospatial patterns of care by individual and area-level (e.g., census tract-level) characteristics.
DATA COLLECTION/EXTRACTION METHODS: Multivariate generalized estimating equation models were used to determine factors associated with receiving cancer treatment within residential counties, residential hospital service areas, and in-state (versus out-of-state) care.
We observed significant differences in geospatial patterns of cancer treatment by race/ethnicity, insurance type, and area-level factors. Even after adjusting for tumor characteristics, insurance type, and other demographic factors, non-Hispanic Black patients had a 5.6% higher likelihood of receiving care within their own residential county compared to non-Hispanic White patients (95% CI: 2.80-8.41). Patients insured with Medicaid and those without insurance had higher likelihoods of receiving care within their residential county compared to privately insured individuals. Patients living in census tracts with the highest quintile of social vulnerability were 4.6% more likely to receive treatment within their residential county (95% CI: 0.00-9.30) and were 2.7% less likely to seek out-of-state care (95% CI: -4.85 to -0.61).
Urban populations are not homogenous in their geospatial patterns of cancer care utilization, and individuals living in areas with greater social vulnerability may have limited opportunities to access care outside of their immediate residential county. Geographically tailored efforts, along with socioculturally tailored efforts, are needed to help improve equity in cancer care access.
在新泽西州（该州大部分居民居住在城市地区），研究不同人群的癌症护理利用的地理空间模式，该州的人口多样化。
数据来源/研究范围：我们使用了 2012 年至 2014 年新泽西州癌症登记处的数据。
我们研究了 20-65 岁被诊断患有乳腺癌、结直肠癌或浸润性宫颈癌的患者的癌症治疗地点，并调查了个体和地区（例如，普查区）特征对护理地理空间模式的差异。
数据收集/提取方法：使用多变量广义估计方程模型确定与在居住县、居住医院服务区内接受癌症治疗以及在州内（而非州外）接受治疗相关的因素。
我们观察到癌症治疗的地理空间模式因种族/族裔、保险类型和地区水平因素而存在显著差异。即使在调整了肿瘤特征、保险类型和其他人口统计学因素后，与非西班牙裔白人患者相比，非西班牙裔黑人患者在自己居住的县内接受治疗的可能性高 5.6%（95%CI：2.80-8.41）。与私人保险患者相比，医疗保险和无保险患者在自己居住的县内接受治疗的可能性更高。居住在社会脆弱性最高五分位数普查区的患者在自己居住的县内接受治疗的可能性高 4.6%（95%CI：0.00-9.30），而寻求州外治疗的可能性低 2.7%（95%CI：-4.85 至-0.61）。
城市人口在癌症护理利用的地理空间模式上并不同质，居住在社会脆弱性较大地区的个体可能获得县外治疗的机会有限。需要有针对性的地理和有针对性的社会文化努力，以帮助改善癌症护理获取方面的公平性。
