Tracking community sentinel events: Breast cancer mortality and neighborhood risk for advanced-stage tumors in Denver

T.L. Andres, A.E. Baron, R.A. Wright and W.M. Marine

American Journal of Public Health, 1996, vol. 86, issue 5, 717-722

Abstract: Objectives. The incidence of related sentinel events-breast cancer mortality and neighborhood-specific morbidity for advanced stage at diagnosis-were calculated for women likely to use a community health center in Denver, Colo. Methods. For the center's service area, neighborhoods (n = 37) were defined by program use. Mortality rates and proportional hazards regression models were estimated for 4189 breast cancer cases recorded between 1979 and 1990. Neighborhood-specific standard morbidity ratios of advanced-stage tumors were based on age-specific rates applied to the entire community. Results. Service area residents were more likely to present with advanced tumors (odds ratio [OR] = 1.4; 95% [CI] = 1.2, 1.5). After adjustment, advanced-stage disease and socioeconomic-demographic status, but not race-ethnicity, contributed significantly to survival. Two neighborhoods (6.5% of the population at risk) with standard morbidity ratios of 2.1 (95% CI = 1.3, 3.4) and 1.7 (95% CI = 1.2, 2.5) accounted for 42% of the excess cases of advanced-stage tumors between 1986 and 1990. Conclusions. Neighborhood variation in advanced-stage cancer can serve as the basis for efforts to improve access to breast cancer screening.

Date: 1996
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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:1996:86:5:717-722_1

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