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.
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.
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, contribued 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.
Neighborhood variation in advanced-stage cancer can serve as the basis for efforts to improve access to breast cancer screening.
Mots-clés Pascal : Accessibilité, Soin santé primaire, Tumeur maligne, Glande mammaire, Mortalité, Morbidité, Stade avancé, Femme, Homme, Centre santé, Répartition géographique, Système santé, Colorado, Etats Unis, Amérique du Nord, Amérique, Epidémiologie, Glande mammaire pathologie
Mots-clés Pascal anglais : Accessibility, Primary health care, Malignant tumor, Mammary gland, Mortality, Morbidity, Advanced stage, Woman, Human, Health center, Geographic distribution, Health system, Colorado, United States, North America, America, Epidemiology, Mammary gland diseases
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0273304
Code Inist : 002B30A01B. Création : 199608.