Neighborhood and Geographic Factors Associated with Diagnostic Resolution After an Abnormal Breast or Cervical Cancer Screening Test Among Women Enrolled in a Patient Navigator Program

Abstract

Abstract This study's aim was to assess the associations between neighborhood and geographic factors and diagnostic resolution within 12 months following an abnormal screening test for breast or cervical cancer among participants of the Ohio Patient Navigator Research Program. Methods: Patient (demographic, psychosocial, and socioeconomic status [SES]) and neighborhood (SES, racial segregation, healthcare access) factors of 776 women attending one of 16 clinics and living in one of 285 census tracts in greater Columbus, Ohio were examined. Women were randomized at the clinic level to determine receipt of the navigation intervention. Multilevel logistic regression was used to estimate associations between these factors and diagnostic resolution while controlling for clinic and neighborhood clustering. Spatial analysis assessed the presence of geographic disparities (i.e., regions of significantly high odds of not resolving). Results: After adjustment for individual-level SES and the receipt of the clinic-level navigation intervention, there was a significant inverse association between neighborhood-level percent of residents without a bachelor's degree and odds of diagnostic resolution (odds ratio = 0.79, 95% confidence interval = 0.63–0.98). Adjustment for neighborhood percent of residents without a bachelor's degree accounted for geographic disparities in diagnostic resolution. Racial segregation, home-to-clinic distance and PN were not associated with odds of resolution. Conclusions: Women were more likely to have diagnostically resolved 12 months following an abnormal breast or cervical cancer screening test if they lived in neighborhoods of higher SES. Geographic disparities in diagnostic resolution could be reduced if there was no variation in neighborhood SES.