Abstract
BackgroundColorectal and breast cancers are the second most common causes of cancer deaths in the US. Population cancer screening rates are suboptimal and many cancers are diagnosed at an advanced stage, which results in increased morbidity and mortality. Younger populations are more likely to be diagnosed at a later stage, and this age disparity is not well understood. We examine the associations between late-stage breast cancer (BC) and colorectal cancer (CRC) diagnoses and multilevel factors, focusing on individual state regulations of insurance and health practitioners, and interactions between such policies and age. We expect state-level regulations are significant predictors of the rates of late-stage diagnosis among younger adults.MethodsWe included adults of all ages, with BC or CRC diagnosed between 2004 –2009, obtained from a newly available cancer population database covering 98 % of all known new cancer cases. We included personal characteristics, linked with a set of county and state-level predictors based on residence. We applied multilevel models to robustly examine differences in risk of late-stage cancer diagnosis across age groups (defined as age 65+ or < 65), focusing specifically on the effects of state regulatory factors and their interactions with age.ResultsLate stage BC diagnoses range from 24 %-36 %, while CRC diagnoses range from 54 %-60 % of newly diagnosed BC or CRC cases across states. After controlling statistically for many confounding factors at three levels, age < 65 is the largest person-level predictor for CRC, while black race is the largest predictor for BC. State regulations of health markets exhibit significant interactions with age groups.ConclusionsThe state regulatory climate is an important predictor of late-stage BC and CRC diagnoses, especially among people younger than Medicare eligible age (65). State regulations can enhance the climate of access for younger, less well-insured or uninsured persons who fall outside normative screening guidelines.
Highlights
Colorectal and breast cancers are the second most common causes of cancer deaths in the US
We use newly available data that are representative of the vast majority of the US to answer several new research questions, including: Holding constant environmental factors, do the odds of late-stage cancer diagnosis vary among people
The database was developed by a joint effort by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI) to provide a single, pooled-state database of reconciled, comparable cancer information geocoded at the local level to facilitate cancer control planning and evaluation [12]
Summary
We examined cancer cases from the United States Cancer Statistics (USCS) database, which is a population-based surveillance system of cancer registries with data representing 98 % of the U.S population. We hypothesize that these three state regulations could plausibly affect the availability of information regarding the importance of cancer screening, or the accessibility of specialists or physicians of choice to better align patients with the best medical advice. In areas with greater shortages of MDs, the NPs may serve a valuable role in providing primary care services and advice to encourage cancer screening and early detection It remains an empirical question whether these NP practice scope regulations would have greater impact on the younger or the older population groups, which we investigate here. Statistical analysis We used multilevel models to examine associations with late stage cancer diagnosis from predictors at person, county and state levels. The models for each cancer type used identical predictors, except CRC included an indicator to differentiate males and females
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