Role of community risk factors and resources on breast carcinoma stage at diagnosis

BACKGROUND The current study investigated the individual and community determinants of breast carcinoma stage at diagnosis (BCSAD) using multiple data sources merged with cancer registry data. The literature review yielded 5 studies that analyzed cancer registry data merged with community‐level variables (1995–2004). METHODS Community variables constructed for the current study reflected social and economic risk factors, physician supply, and health maintenance organization penetration. Multivariate logistic regression was used to identify the significant predictors of increasingly progressive BCSAD. RESULTS Disparities remained for black and Hispanic females in California, who were least likely to be diagnosed early compared with their white counterparts. Younger (< 40 years) and middle‐aged (40–64 years) females were less likely to be diagnosed with early BCSAD, compared with older females (≥ 65 years). Utilizing services at hospitals serving a lower volume of patients with breast carcinoma was associated with later BCSAD. After controlling for individual‐level factors, community‐level variables constructed at the census block group and county level were tested. If a woman resided in a neighborhood with greater percentages of female‐headed households, persons living below the poverty level, less educated people, and more recent immigrants, then her chances of being diagnosed at an earlier stage were diminished. If, conversely, she resided in a neighborhood with greater percentages of females ≥ 65 years (a proxy for Medicare coverage), her access to medical care and the probability of earlier BCSAD increased. County‐level insurance rates and residing in counties where greater percentages of women ever had a mammogram were associated with in situ and early‐stage diagnosis. Similarly, the supply of primary care physicians and radiologists was associated positively with earlier BCSAD. CONCLUSIONS Results confirmed community‐level predictors of socioeconomic and delivery system context matter, although the individual‐level predictors showed a stronger effect. Nevertheless, analysis of community variables is promising for guiding and evaluating the effects of health policy and developing community and delivery system interventions for earlier detection and treatment of breast carcinoma. Cancer 2005. © 2005 American Cancer Society. Compared with individual‐level predictors, community‐level predictors explained to a greater extent the differences in breast carci