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. 2013 Apr 29;8(4):e61879.
doi: 10.1371/journal.pone.0061879. Print 2013.

Trends in breast cancer stage and mortality in Michigan (1992-2009) by race, socioeconomic status, and area healthcare resources

Tomi F Akinyemiju  1 , Amr S Soliman, Glenn Copeland, Mousumi Banerjee, Kendra Schwartz, Sofia D Merajver
Affiliations

Trends in breast cancer stage and mortality in Michigan (1992-2009) by race, socioeconomic status, and area healthcare resources

Tomi F Akinyemiju et al. PLoS One. .

Abstract

The long-term effect of socioeconomic status (SES) and healthcare resources availability (HCA) on breast cancer stage of presentation and mortality rates among patients in Michigan is unclear. Using data from the Michigan Department of Community Health (MDCH) between 1992 and 2009, we calculated annual proportions of late-stage diagnosis and age-adjusted breast cancer mortality rates by race and zip code in Michigan. SES and HCA were defined at the zip-code level. Joinpoint regression was used to compare the Average Annual Percent Change (AAPC) in the median zip-code level percent late stage diagnosis and mortality rate for blacks and whites and for each level of SES and HCA. Between 1992 and 2009, the proportion of late stage diagnosis increased among white women [AAPC = 1.0 (0.4, 1.6)], but was statistically unchanged among black women [AAPC = -0.5 (-1.9, 0.8)]. The breast cancer mortality rate declined among whites [AAPC = -1.3% (-1.8,-0.8)], but remained statistically unchanged among blacks [AAPC = -0.3% (-0.3, 1.0)]. In all SES and HCA area types, disparities in percent late stage between blacks and whites appeared to narrow over time, while the differences in breast cancer mortality rates between blacks and whites appeared to increase over time.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Geographical Distribution of Socio-economic Status among Michigan zip-codes.
Figure 2
Figure 2. Geographical Distribution of Area Healthcare Resources among Michigan zip-codes.
Figure 3
Figure 3. Median Predicted Zip-Code Percent Late Stage Diagnosis (1992–2008) and Age-Adjusted Mortality Rate (1992–2009) by Race, SES and HCA.
Figure 4
Figure 4. Median Predicted Zip-Code Percent Late Stage Diagnosis (1992–2008) by Race and Neighborhood Type.
Figure 5
Figure 5. Median Predicted Zip Code Age-Adjusted Mortality Rate (1992–2008) by Race and Neighborhood Type.
See this image and copyright information in PMC

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