Rural - urban inequalities in late-stage breast cancer: spatial and social dimensions of risk and access.
Environ Plann B Plann Des
; 38(4): 726-740, 2011 Aug.
Article
em En
| MEDLINE
| ID: mdl-23335830
ABSTRACT
Rural - urban inequalities in health and access to health care have long been of concern in health-policy formulation. Understanding these inequalities is critically important in efforts to plan a more effective geographical distribution of public health resources and programs. Socially and ethnically diverse populations are likely to exhibit different rural - urban gradients in health and well-being because of their varying experiences of place environments, yet little is known about the interplay between social and spatial inequalities. Using data from the Illinois State Cancer Registry, we investigate rural - urban inequalities in late-stage breast cancer diagnosis both for the overall population and for African-Americans, and the impacts of socioeconomic deprivation and spatial access to health care. Changes over time are analyzed from 1988 - 92 to 1998 - 2002, periods of heightened breast cancer awareness and increased access to screening. In both time periods, the risk of late-stage diagnosis is highest among patients living in the most urbanized areas, an indication of urban disadvantage. Multilevel modeling results indicate that rural - urban inequalities in risk are associated with differences in the demographic characteristics of area populations and differences in the social and spatial characteristics of the places in which they live. For African-American breast cancer patients, the rural - urban gradient is reversed, with higher risks among patients living outside the city of Chicago, suggesting a distinct set of health-related risks and place experiences that inhibit early breast cancer detection. Findings emphasize the need for combining spatial and social targeting in locating cancer prevention and treatment programs.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Idioma:
En
Revista:
Environ Plann B Plann Des
Ano de publicação:
2011
Tipo de documento:
Article
País de afiliação:
Estados Unidos