Accessing medical services among women living in inner-city areas of the US

Background: Health care markets may not adequately serve poor, less educated and uninsured women. In previous research, we found that women living in poor, medically underserved, inner-city areas were at significantly increased risk of a late-stage breast cancer diagnosis.

Objectives: Since mammography screening is widely used, requires medical intervention, and yields earlier breast cancer diagnosis, we use early diagnostic stage as a proxy for timely primary care services. New data on physician supply enable us to address the question: Do more physicians within a neighborhood improve access to medical care and lower the probability of late-stage breast cancer?

Methods: We modeled neighborhood characteristics in 2000 in Detroit, Atlanta and San Francisco, three areas with dispersed income levels and racially and ethnically diverse populations. Contextual variables include poverty level, medically-underserved designation, travel time to work, percent of linguistically isolated households, employment, educational level and racial composition. We linked these area data with individual data on race, age, martial status and city of residence from the 2000 SEER cancer registry.

Results and Discussion: Residence in high poverty neighborhoods explained a large part of the variation in late-stage breast cancer in both 1990 and 2000. The residential poverty/late-stage cancer gradient persisted over the two time periods, despite a decline in late-stage diagnoses overall. When location of doctor's offices was added to the 2000 model, it was significant for Detroit and white women. Educational level within a neighborhood was also an important predictor.