Abstract
IntroductionPrevious studies have shown that delayed detection of several cancers is related to socioeconomic deprivation as measured by the Wellbeing Index (WI) in Texas, the United States of America (USA). The current study investigates whether delayed cancer detection is related to lack of health insurance, physician shortage and higher percentages of Hispanics rather than WI per se since these factors are directly related to delayed cancer detection and may confound WI.MethodsCancer data and potential determinants of delayed cancer detection are derived from Texas Cancer Registry, Texas State Data Center, and Texas Department of State Health Services and U.S. Census Bureau. Texas cancer data from 1997 to 2003 are aggregated to calculate age-adjusted late- and early-stage cancer detection rates. The WI for each county is computed using data from the USA Census 2000. A weighted Tobit regression model is used to account for population size and censoring. The percentage of late-stage cancer cases is the dependent variable while independent variables include WI and the aforementioned potential confounders.ResultsDelayed detection of breast, lung, colorectal and female genital cancers is associated with higher percentage of uninsured residents (p < 0.05). Delayed detection is also associated with physician shortage and lower percentages of Hispanics for certain cancers ceteris paribus ( p < 0.05). The percentage of late-stage cases is positively correlated with WI for lung, and prostate cancers after adjusting for confounders ( p < 0.05).ConclusionsThe percentages of uninsured and Hispanic residents as well as physician supply are determinants of delayed detection for several cancers independently of WI, and vice versa. Identification of these determinants provides the evidence-base critical for decision makers to address specific issues for promoting early detection in effective cancer control.
Highlights
Previous studies have shown that delayed detection of several cancers is related to socioeconomic deprivation as measured by the Wellbeing Index (WI) in Texas, the United States of America (USA)
We use data for lung-bronchial, breast, prostate, female genital system, and colorectal cancers from 2000 as well as data three years before and three years after 2000 in order to be consistent with socioeconomic data derived from USA census 2000 assuming that these socioeconomic variables do not deviate from 2000 census data significantly 3 year before and after 2000
It is likely that factors other than those that are studied may be responsible for the correlation between WI and delayed detection of lung-bronchial and prostate cancers such as potentially lower level of education, lack of awareness of cancer control measures, malnutrition, etc. associated with socioeconomic deprivation
Summary
Previous studies have shown that delayed detection of several cancers is related to socioeconomic deprivation as measured by the Wellbeing Index (WI) in Texas, the United States of America (USA). Despite the impact of cancer education programs [3] including recent interactive computer-based education [4] for early detection and Health status and health disparities among different social and ethnic groups are to a large degree determined by socioeconomic status in general [6,7]. Health behavior including regular checkups and participation in cancer surveillance among high risk groups may be determined by health insurance coverage which is often absent in socioeconomically deprived individuals. To quantify socioeconomic deprivation for a given community (e.g., census track), Albrecht and Ramasubramanian developed a Wellbeing
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