Influence of primary care physician availability and socioeconomic deprivation on breast cancer from 1988 to 2008: a spatio-temporal analysis

Lung-Chang Chien; Anjali D Deshpande; Donna B Jeffe; Mario Schootman

doi:10.1371/journal.pone.0035737

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Influence of primary care physician availability and socioeconomic deprivation on breast cancer from 1988 to 2008: a spatio-temporal analysis

Journal article

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Peer reviewed

Influence of primary care physician availability and socioeconomic deprivation on breast cancer from 1988 to 2008: a spatio-temporal analysis

Lung-Chang Chien, Anjali D Deshpande, Donna B Jeffe and Mario Schootman

PloS one, Vol.7(4), pp.e35737-e35737

2012

DOI: 10.1371/journal.pone.0035737

PMCID: PMC3335009

PMID: 22536433

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Abstract

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States. It is unclear how county-level primary care physician (PCP) availability and socioeconomic deprivation affect the spatial and temporal variation of breast cancer incidence and mortality. We used the 1988-2008 public-use county-based data from nine Surveillance, Epidemiology, and End Results (SEER) programs to analyze the temporal and spatial disparity of PCP availability and socioeconomic deprivation on early-stage incidence, advanced-stage incidence and breast cancer mortality. The spatio-temporal analysis was implemented by a novel structural additive modeling approach. Greater PCP availability was significantly associated with higher early-stage incidence, advanced-stage incidence and mortality during the entire study period while socioeconomic deprivation was significantly negatively associated with early-stage incidence, advanced-stage incidence, and mortality up to 1992. However, the observed influence of PCP availability and socioeconomic deprivation varied by county. We showed important associations of PCP availability and socioeconomic deprivation with the three breast cancer indicators. However, the effect of these associations varied over time and across counties. The association of PCP availability and socioeconomic deprivation was stronger in selected counties.

United States - epidemiology

Humans

Models, Statistical

Socioeconomic Factors

Incidence

Regression Analysis

Breast Neoplasms - pathology

Health Services Accessibility

Bayes Theorem

Breast Neoplasms - mortality

Female

Primary Health Care

Neoplasm Staging

Details

Title: Subtitle: Influence of primary care physician availability and socioeconomic deprivation on breast cancer from 1988 to 2008: a spatio-temporal analysis
Creators: Lung-Chang Chien - Division of Health Behavior Research, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America. lchien@dom.wustl.edu
Anjali D Deshpande
Donna B Jeffe
Mario Schootman
Resource Type: Journal article
Publication Details: PloS one, Vol.7(4), pp.e35737-e35737
DOI: 10.1371/journal.pone.0035737
PMID: 22536433
PMCID: PMC3335009
NLM abbreviation: PLoS One
ISSN: 1932-6203
eISSN: 1932-6203
Publisher: United States
Grant note: CA91842 / NCI NIH HHS P30 CA091842 / NCI NIH HHS CA109675 / NCI NIH HHS R01 CA109675 / NCI NIH HHS
Language: English
Date published: 2012
Academic Unit: Epidemiology
Record Identifier: 9983996090002771

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