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. 2021 May 3;21(1):186.
doi: 10.1186/s12905-021-01274-9.

Assessing health disparities in breast cancer incidence burden in Tennessee: geospatial analysis

Bonita Salmeron  1 , Lohuwa Mamudu  2 , Xiaohui Liu  1 , Martin Whiteside  3 , Faustine Williams  4
Affiliations

Assessing health disparities in breast cancer incidence burden in Tennessee: geospatial analysis

Bonita Salmeron et al. BMC Womens Health. .

Abstract

Background: Tennessee women experience the 12th highest breast cancer mortality in the United States. We examined the geographic differences in breast cancer incidence in Tennessee between Appalachian and non-Appalachian counties from 2005 to 2015.

Methods: We used ArcGIS 10.7 geospatial analysis and logistic regression on the Tennessee Cancer Registry incidence data for adult women aged ≥ 18 years (N = 59,287) who were diagnosed with breast cancer from 2005 to 2015 to evaluate distribution patterns by Appalachian county designation. The Tennessee Cancer Registry is a population-based, central cancer registry serving the citizens of Tennessee and was established by Tennessee law to collect and monitor cancer incidence. The main outcome was breast cancer stage at diagnosis. Independent variables were age, race, marital status, type of health insurance, and county of residence.

Results: Majority of the sample were White (85.5%), married (58.6%), aged ≥ 70 (31.3%) and diagnosed with an early stage breast cancer (69.6%). More than half of the women had public health insurance (54.2%), followed by private health insurance coverage (44.4%). Over half of the women resided in non-Appalachian counties, whereas 47.6% were in the Appalachian counties. We observed a significant association among breast cancer patients with respect to marital status and type of health insurance coverage (p = < 0.0001). While the logistic regression did not show a significant result between county of residence and breast cancer incidence, the spatial analysis revealed geographic differences between Appalachian and non-Appalachian counties. The highest incidence rates of 997.49-1164.59/100,000 were reported in 6 Appalachian counties (Anderson, Blount, Knox, Rhea, Roane, and Van Buren) compared to 3 non-Appalachian counties (Fayette, Marshall, and Williamson).

Conclusions: There is a need to expand resources in Appalachian Tennessee to enhance breast cancer screening and early detection. Using geospatial techniques can further elucidate disparities that may be overlooked in conventional linear analyses to improve women's cancer health and associated outcomes.

Keywords: Appalachian Tennessee; Breast cancer; Geographic information system; Health disparities; Non-appalachian Tennessee.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Appalachian region. Map by Appalachian Regional Commission
Fig. 2
Fig. 2
Overall female breast cancer rates, 2005–2015. Map generated by the authors
See this image and copyright information in PMC

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References

    1. Hunt BR, Whitman S, Hurlbert MS. Increasing Black: White disparities in breast cancer mortality in the 50 largest cities in the United States. Cancer Epidemiol. 2014;38(2):118–123. - PubMed
    1. Williams F, Jeanetta S, James AS. Geographical location and stage of breast cancer diagnosis: a systematic review of the literature. J Health Care Poor Underserved. 2016;27(3):1357–1383. - PubMed
    1. The Appalachian Region https://www.arc.gov/appalachian_region/TheAppalachianRegion.asp. Accessed 17 Dec 2020.
    1. Marshall J, Thomas L, Lane N, Holmes G, Arcury T, Randolph R, Silberman P, Holding W, Villamil Lea: Health Disparities in Appalachia August 2017: Creating a culture of health in Appalachia: disparities and bright spots https://www.arc.gov/research/researchreportdetails.asp?REPORT_ID=138. Accessed 16 July 2019.
    1. Behringer B, Friedell GH, Dorgan KA, Hutson SP, Naney C, Phillips A, Cantrell E. Understanding the challenges of reducing cancer in Appalachia: addressing a place-based health disparity population. Calif J Health Promot. 2007;5:40–49.

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