State characteristics and late-stage cancer diagnosis: Multilevel factors and spatial interactions across the entire US cancer population

Currently, over 40% of breast and colorectal cancers are diagnosed at an advanced stage, which results in higher morbidity and mortality than would obtain with optimal cancer screening utilization. Our purpose is to provide information to improve US population breast and colorectal cancer outcomes through earlier detection of these cancers.  We use multilevel modeling to examine Why disparities in late-stage cancer diagnoses are observed.  Our earlier study of individuals in 11 states with SEER Registries found that characteristics of state insurance environments are significantly associated with late-stage cancer diagnosis outcomes.  The purpose here is to expand the analysis to cover all of the US and to examine a more comprehensive set of state insurance regulations, and the vastly more comprehensive set of local community contexts.

We use the cancer population included in the National Program of Cancer Registries, with special permissions granted by NCHS/CDC to conduct this research inside the secure federal NCHS/Census Research Data Center labs. To model disparities in the likelihood of late-stage BC and CRC cancer at first cancer diagnosis, we use a multilevel modeling approach that includes person, county, and state level characteristics to examine Why there are geographic disparities in late stage cancer diagnoses.  A unique aspect of this population health research is our focus on state level characteristics (characteristics of states’ insurance markets and managed care environments, scope of practice regulations for nurse practitioners, and insurance market regulations relevant to breast or colorectal cancer screening) to help model the geographic disparities in late-stage diagnoses.