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APHA Scientific Session and Event Listing

Recorded presentation

Elizabeth Tarlov, PhD¹, Shannon N. Zenk, PhD², Richard Warnecke, PhD³, Richard T. Campbell, PhD³, and Richard Block, PhD⁴. (1) Center for Population Health and Health Disparities, UIC Cancer Center, VA Information Resource Center, Edward Hines, Jr. VA Hospital, PO Box 5000 (151V), Hines, IL 60141, 708 202 2254, elizabeth.tarlov@va.gov, (2) Department of Public Health, Mental Health, and Administrative Nursing, University of Illinois at Chicago College of Nursing, 845 South Damen Ave. (M/C 802), Chicago, IL 60612, (3) Center for Population Health and Health Disparities, UIC Cancer Center, University of Illinois at Chicago, Westside Research Building, 1747 W. Roosevelt Road Rm.558, M/C 275, Chicago, IL 60608-1264, (4) Department of Sociology, Loyola University Chicago, 6525 N. Sheridan Road, Damen Hall 931, Chicago, IL 60626

BACKGROUND: Despite the contributions of many studies investigating barriers to mammography participation, reasons for underutilization remain incompletely understood. OBJECTIVE: We investigate whether characteristics of the urban neighborhoods in which mammography facilities are located affect service use by examining the association between those characteristics and stage at diagnosis among Chicago residents with breast cancer. METHODS: In this retrospective cohort study, we use stage at diagnosis as a surrogate measure of routine annual mammography utilization. Using a geographic information system, we identified five facilities nearest to the residence of each cancer case. We test hypotheses relating facility area characteristics to cancer stage using information on cancer cases from the Illinois State Cancer Registry and on facility area characteristics from the Chicago Police Department, the Chicago Transit Authority, and the US Census. RESULTS: In bivariate analyses, unfavorable stage was associated with race/ethnicity, lower levels of education and income, and greater case-facility dissimilarity in neighborhood racial composition, but not with other facility area characteristics. Preliminary results of ordered logistic regression analyses reveal that higher crime rates in areas surrounding nearby facilities were associated with lower odds of later stage disease. The number of public transportation lines serving the residential area, but not those serving nearby facility areas, was associated with higher odds of later stage disease. IMPLICATIONS FOR ADDRESSING DISPARITIES: This study will contribute new information about the determinants of disparities in breast cancer stage at diagnosis and help to identify characteristics of the urban environment that are important for healthcare utilization.

Learning Objectives: At the conclusion of the session, the participant will be able to

• Identify data sources that, through record linkage and GIS, can be used to characterize and illuminate differences between urban neighborhoods for the study of contextual effects on health.
• Discuss contextual factors, particular to the urban environment, that may affect mammography utlization and stage of breast cancer at diagnosis.
• Describe the contribution of those factors to race/ethnic and economic disparities in late stage diagnosis.

Keywords: Breast Cancer, Health Disparities

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation