Journal Article

Spatial Heterogeneity in Cancer Control Planning and Cancer Screening Behavior

Mobley, Lee R., Kuo, Tzy-Mey, Subramanian, Sujha, Urato, Matthew, Watson, Lisa, Anselin, Luc

2012

Overview

Each state is autonomous in its comprehensive cancer control (CCC) program, and considerable heterogeneity exists in the program plans, but researchers often focus on the concept of nationally representative data and pool observations across states using regression analysis to come up with average effects when interpreting results. Due to considerable state autonomy and heterogeneity in various dimensions-including culture, politics, historical precedent, regulatory environment, and CCC efforts-it is important to examine states separately and to use geographic analysis to translate findings in place and time. We used 100 percent population data for Medicare-insured persons aged sixty-five or older and examined predictors of breast cancer (BC) and colorectal cancer (CRC) screening from 2001 to 2005. Examining BC and CRC screening behavior separately in each state, we performed 100 multilevel regressions. We summarize the state-specific findings of racial disparities in screening for either cancer in a single bivariate map of the fifty states, producing a separate map for African American and for Hispanic disparities in each state relative to whites. The maps serve to spatially translate the voluminous regression findings regarding statistically significant disparities between whites and minorities in cancer screening within states. Qualitative comparisons can be made of the states' disparity environments or for a state against a national benchmark using the bivariate maps. We find that African Americans in Michigan and Hispanics in New Jersey are significantly more likely than whites to utilize CRC screening and that Hispanics in six states are significantly and persistently more likely to utilize mammography than whites. We stress the importance of spatial translation research for informing and evaluating CCC activities within states and over time.

• Publisher: Taylor & Francis Group,Taylor & Francis Ltd
• Subject: African Americans / Autonomy / bivariate mapping / Breast cancer / Cancer / Cancer screening / cartografía bivariada / Colorectal cancer / Colorectal carcinoma / comprehensive cancer control / control amplio del cáncer / Culture / disparidades geográficas / geographic disparities / Health behavior / Health care / Health Care Provision, Access, and Utilization / Health inequality / Health policy / heterogeneidad espacial / Heterogeneity / Hispanic Americans / Hispanics / Interpreting / Latin American cultural groups / Mammography / Medical screening / Medicare / Michigan / Minorities / Minority groups / Multilevel models / New Jersey / Population / Racial differences / Racial differentiation / Racial inequality / Regression analysis / Regulation / Spatial analysis / spatial heterogeneity / spatial translation / State estimation / Statistical significance / Tests / Time use / traducción espacial / U.S.A / White people / 二元映射图 / 全面的癌症控制 / 地域差异 / 空间差异性 / 空间翻译