Abstract
BackgroundBreast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States. It is unclear how county-level primary care physician (PCP) availability and socioeconomic deprivation affect the spatial and temporal variation of breast cancer incidence and mortality.MethodsWe used the 1988–2008 public-use county-based data from nine Surveillance, Epidemiology, and End Results (SEER) programs to analyze the temporal and spatial disparity of PCP availability and socioeconomic deprivation on early-stage incidence, advanced-stage incidence and breast cancer mortality. The spatio-temporal analysis was implemented by a novel structural additive modeling approach.ResultsGreater PCP availability was significantly associated with higher early-stage incidence, advanced-stage incidence and mortality during the entire study period while socioeconomic deprivation was significantly negatively associated with early-stage incidence, advanced-stage incidence, and mortality up to 1992. However, the observed influence of PCP availability and socioeconomic deprivation varied by county.ConclusionsWe showed important associations of PCP availability and socioeconomic deprivation with the three breast cancer indicators. However, the effect of these associations varied over time and across counties. The association of PCP availability and socioeconomic deprivation was stronger in selected counties.
Highlights
Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States
The association of primary care physician (PCP) availability and socioeconomic deprivation was stronger in selected counties
We examined the spatial distributions in breast cancer incidence and mortality rates and possible nonlinear effects using structural additive regression (STAR) models in order to account for temporal autoregressive correlation and spatial autocorrelation among 200 counties during 1988–2008 [26]
Summary
Breast cancer indicators, such as incidence and mortality, vary over time and across geographic areas in the US [1]. It is unclear how county-level primary care physician (PCP) availability and socioeconomic deprivation affect the spatial and temporal variation of breast cancer incidence and mortality
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