Disparities in Late-Stage Cancer Diagnoses in 1990 and 2000: A Comparative Study of Three American Cities
- Presenter:
Chair: James Marton; Discussant: Sylvia Brand Mon June 5, 2006 10:45-12:15 Room 235
Rationale: Previously, we reported that women living in poor, medically underserved, inner-city areas were at significantly increased risk of late-stage cancer diagnosis in 1990. Breast and cervical screening are widely used in the US to detect early stage cancer. We found that in neighborhoods where the odds of late-stage diagnoses are high, women face access barriers to screening.
Objectives: We use data on inner-city markets and residents to model economic changes over a 10 year period. Other researchers found independent effects of neighborhood unemployment, racial composition, environmental threats, and low socioeconomic status on a range of health outcomes. Analysis of the supply of health services, including the location of hospitals, clinics and drugstores, has been largely absent from the neighborhoods and health literature. We will examine these variables in our follow-up analysis.
Methodology: For both the initial 1989-1990 study and the 1999-2000 follow-up, we used variables from Surveillance, Epidemiology, and End Results (SEER) cancer registry data (race, age, marital status and city of residence) and linked them with 1990 and 2000 Census data at the tract level. We linked a measure of medical underservice (MUA) developed by the Health Resources and Services Administration (HRSA), and a measure of extreme poverty, defined as a Census tract in which more than 40% of the population lives in poverty. We analyze Atlanta, Detroit, and San Francisco, three major metropolitan areas with both high and low-income tracts and racially and ethnically diverse populations.
Results: In 1989-1990 we found that residence in an extremely poor or medically underserved area increased the likelihood of a late-stage cancer diagnosis. City of residence, and race/ethnicity also were major determining factors. Detroit represented the clearest case of market failure in the delivery of cancer screening services. Our preliminary studies for the 1999-2000 period show the same set of factors is associated with late-stage diagnosis. Despite a significant decline in late-stage diagnoses between 1990 and 2000; and a dramatic (24%) decline in the nationwide number of residents in extremely poor neighborhoods, our findings confirm that health care markets are underserving economically disadvantaged locations. Further, many poor neighborhoods without the federal MUA designation in 1990 still had not received it in 2000.
Conclusion: Our results identify areas in which women are not receiving preventive cancer services. In these areas, the combination of low income and social disadvantage act to reduce the health care choices available to women. We evaluate whether the same neighborhoods we examined in 1990 have improved their ability to provide residents access to services in 2000. For 2000, we analyze the location of health care delivery factors in the three inner cities, especially how spatial and racial divides foster late-stage diagnoses in the clearest case of market failure, Detroit.
