Abstract:
OBJECTIVE:To evaluate distribution of hospital-level cancer diagnosis and treatment technologies along dimensions of racial residential segregation. STUDY DESIGN:Cross-sectional analysis of residential segregation and availability of technologies associated with cancer diagnosis and treatment. METHODS:American Hospital Association data were merged with American Community Survey data, and hospital was the unit of analysis. Isolation index and Atkinson's index were calculated for racial residential segregation for the census tract in which the hospital is located based on the composite census block groups. Logistic regression was used to model presence of cancer technologies as a function of percent below poverty (scaled 1-10), number of neighboring hospitals, and rural status. RESULTS:Segregation measured by isolation index was associated with the availability of some technologies, independent of percentage below 125% poverty line, number of neighboring hospitals, and rural status. Diagnostic cancer technologies, such as CT scan (odds ratio [OR] = 0.928, 95% confidence interval [CI]: 0.894, 0.964), ultrasound (OR = 0.961, 95% CI: 0.927, 0.997), mammography (OR = 0.943, 95% CI: 0.914, 0.974), optical colonoscopy (OR = 0.932, 95% CI: 0.904, 0.961), and full-field digital mammography (OR = 0.948, 95% CI: 0.920, 0.977) and therapeutic cancer technology such as chemo therapy (OR = 0.963, 95% CI: 0.934, 0.992) appear to be less available in neighborhoods with higher isolation index. However, when segregation is measured by Atkinson's index, CT scan (OR = 1.064, 95% CI: 1.010, 1.121), ultrasound (OR = 1.087, 95% CI: 1.035, 1.141), mammography (OR = 1.094, 95% CI: 1.049, 1.141), and optical colonoscopy (OR = 1.053, 95% CI: 1.012, 1.095) are more available in neighborhoods with higher Atkinson's index. CONCLUSION:These results suggest that cancer diagnostic capabilities in segregated areas are in the pathway between residential segregation and cancer treatment process, and future studies should evaluate individual-level associations.
journal_name
Public Healthjournal_title
Public healthauthors
Menon NM,Leslie TF,Frankenfeld CLdoi
10.1016/j.puhe.2020.02.004subject
Has Abstractpub_date
2020-05-01 00:00:00pages
95-101eissn
0033-3506issn
1476-5616pii
S0033-3506(20)30035-4journal_volume
182pub_type
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