Abstract
Recent research suggests living in an economically disadvantaged neighborhood is associated with decreased likelihood of undergoing mammography and increased risk of late-stage breast cancer diagnosis. Long distances and travel times to facilities offering low- or no-fee mammography may be important barriers to adherence to mammography screening recommendations for women living in economically disadvantaged urban neighborhoods, in which African–Americans are disproportionately represented. The purpose of this study was to examine whether the spatial distribution of facilities providing low- or no-fee screening mammography in Chicago, Illinois, is equitable on the basis of neighborhood socioeconomic and racial characteristics. We found that distance and travel times via automobile and public transportation to facilities generally decrease as neighborhood poverty increases. However, we also found that the strength of the association between neighborhood poverty level and two of the spatial accessibility measures—distance and public transportation travel time—is less strong in African–American neighborhoods. Among neighborhoods with the greatest need for facilities (i.e., neighborhoods with the highest proportions of residents in poverty), African–American neighborhoods have longer travel distances and public transportation travel times than neighborhoods with proportionately fewer African–American residents. Thus, it appears that the spatial accessibility of low- and no-fee mammography services is inequitable in Chicago. In view of persistent social disparities in health such as breast cancer outcomes, these findings suggest it is important for researchers to examine the spatial distribution of health resources by both the socioeconomic and racial characteristics of urban neighborhoods.
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References
Ayanian JZ, Kohler BA, Abe T, Epstein AM. The relation between health insurance coverage and clinical outcomes among women with breast cancer. N Engl J Med. 1993;329(5):326–331.
Bradley CJ, Given CW, Roberts C. Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst. 2002;94(7):490–496.
Franzini L, Williams AF, Franklin J, Singletary SE, Theriault RL. Effects of race and socioeconomic status on survival of 1,332 black, Hispanic, and white women with breast cancer. Ann Surg Oncol. 1997;4(2):111–118.
Greenwald HP, Polissar NL, Dayal HH. Race, socioeconomic status and survival in three female cancers. Ethn Health. 1996;1(1):65–75.
Roetzheim RG, Gonzalez EC, Ferrante JM, Pal N, Van Durme DJ, Krischer JP. Effects of health insurance and race on breast carcinoma treatments and outcomes. Cancer J. 2000;89(11):2202–2213.
Du W, Simon MS. Racial disparities in treatment and survival of women with stage I–III breast cancer at a large academic medical center in metropolitan Detroit. Breast Cancer Res Treat. 2005;91(3):243–248.
Hsu JL, Glaser SL, West DW. Racial/ethnic differences in breast cancer survival among San Francisco Bay Area women. J Natl Cancer Inst. 1997;89(17):1311–1312.
Joslyn SA, West MM. Racial differences in breast carcinoma survival. Cancer J. 2000;88(1):114–123.
Li CI, Malone KE, Daling JR. Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med. 2003;163:49–56.
O'Malley CD, Le GM, Glaser SL, Shema SJ, West DW. Socioeconomic status and breast carcinoma survival in four racial/ethnic groups: a population-based study. Cancer J. 2003;97(5):1303–1311.
Ries LAG, Eisner MP, Kosary CL, et al. SEER Cancer Statistics Review, 1975–2002. Bethesda, MD: National Cancer Institute; 2005. Available at: http://seer.cancer.gov/csr/1975_2002/. Accessed July 18, 2005.
Boyer-Chammard A, Taylor TH, Anton-Culver H. Survival differences in breast cancer among racial/ethnic groups: a population-based study. Cancer Detect Prev. 1999;23(6):463–473.
Hunter CP, Redmond CK, Chen VW, et al. Breast cancer: factors associated with stage at diagnosis in black and white women. Black/White Cancer Survival Study Group. J Natl Cancer Inst. 1993;85(14):1129–1137.
Schwartz KL, Crossley-May H, Vigneau FD, Brown K, Banerjee M. Race, socioeconomic status and stage at diagnosis for five common malignancies. Cancer Causes Control. 2003;14:761–766.
U.S.Preventive Services Task Force*. Screening for breast cancer: recommendations and rationale. Ann Intern Med. 2002;137(5_Part_1):344–346.
Smith RA, Saslow D, ndrews Sawyer K, et al. American cancer society guidelines for breast cancer screening: update 2003. CA: A Cancer Journal for Clinicians. 2003;53(3):141–169.
Practice Bulletin Number 42, April 2003: Breast cancer screening. Obstetrics and Gynecology. 2003;101(4):821–832.
Coughlin SS, Uhler RJ, Bobo JK, Caplan L. Breast cancer screening practices among women in the United States, 2000. Cancer Causes Control. 2004;15(2):159–170.
Leatherman S, McCarthy D. Quality of Health Care for Medicare Beneficiaries: a Chartbook. The Commonwealth Fund; May 2005. Available at: http://www.cmwf.org/publications/publications_show.htm?doc_id=275195. Accessed June 15, 2005.
Swan J, Breen N, Coates RJ, Rimer BK, Lee NC. Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer J. 2003;97(6):1528–1540.
Armstrong K, Long JA, Shea JA. Measuring adherence to mammography screening recommendations among low-income women. Prev Med. 2004;38(6):754–760.
Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Prevalence Data [database online]. Available: http://apps.nccd.cdc.gov/brfss/. Atlanta, Georgia: USA Centers for Disease Control and Prevention; 1995–2004.
McPhee SJ, Nguyen TT, Shema SJ, et al. Validation of recall of breast and cervical cancer screening by women in an ethnically diverse population. Prev Med. 2002;35(5):463–473.
Kirby JB, Kaneda T. Neighborhood socioeconomic disadvantage and access to health care. J Health Soc Behav. 2005;46(1):15–31.
Wells BL, Horm JW. Targeting the underserved for breast and cervical cancer screening: the utility of ecological analysis using the National Health Interview Survey. Am J Public Health. 1998;88(10):1484–1489.
Barry J, Breen N. The importance of place of residence in predicting late-stage diagnosis of breast or cervical cancer. Health Place. 2005;11(1):15–29.
Merkin BS, Stevenson L, Powe N. Geographic socioeconomic status, race and advanced stage breast cancer in New York City. Am J Public Health. 2002;92(1):64–70.
Marchick J, Henson DE. Correlations between access to mammography and breast cancer stage at diagnosis. Cancer J. 2005;103(8):1571–1580.
Engelman KK, Hawley DB, Gazaway R, Mosier MC, Ahluwalia JS, Ellerbeck EF. Impact of geographic barriers on the utilization of mammograms by older rural women. J Am Geriatr Soc. 2002;50(1):62–68.
Hyndman JC, Holman CD, Dawes VP. Effect of distance and social disadvantage on the response to invitations to attend mammography screening. J Med Screen. 2000;7(3):141–145.
Kreher NE, Hickner JM, Ruffin MT, Lin CS. Effect of distance and travel time on rural women's compliance with screening mammography: an UPRNet study. Upper Peninsula Research Network. J Fam Pract. 1995;40(2):143–147.
Burgess JF, Jr, DeFiore DA. The effect of distance to VA facilities on the choice and level of utilization of VA outpatient services. Soc Sci Med. 1994;39(1):95–104.
Gregory PM, Malka ES, Kostis JB, Wilson AC, Arora JK, Rhoads GG. Impact of geographic proximity to cardiac revascularization services on service utilization. Med Care. 2000;38(1):45–57.
McCarthy JF, Blow FC. Older patients with serious mental illness: sensitivity to distance barriers for outpatient care. Med Care. 2004;42(11):1073–1080.
Mooney C, Zwanziger J, Phibbs CS, Schmitt S. Is travel distance a barrier to veterans' use of VA hospitals for medical surgical care? Soc Sci Med. 2000;50(12):1743–1755.
Rushton G, Peleg I, Banerjee A, Smith G, West M. Analyzing geographic patterns of disease incidence: rates of late-stage colorectal cancer in Iowa. J Med Syst. 2004;28(3):223–236.
Guagliardo MF. Spatial accessibility of primary care: concepts, methods and challenges. Int J Health Geogr. 2004;3(1):3.
Current Population Survey. Health Insurance Data [database online]. Available: http://www.census.gov/hhes/www/hlthins/data_access.html. Washington, DC: U.S.Census Bureau, Housing and Household Economic Statistics Division; 2004.
Suter LG, Nakano CY, Elmore JG. The personal costs and convenience of screening mammography. J Womens Health Gend Based Med. 2002;11(7):667–672.
McAlearney AS, Reeves KW, Tatum C, Paskett ED. Perceptions of insurance coverage for screening mammography among women in need of screening. Cancer J. 2005;103(12):2473–2480.
The National Breast and Cervical Cancer Early Detection Program—Reducing Mortality Through Screening. US Department of Health and Human Services, Centers for Disease Control and Prevention Web site; May 2004. Available at: http://www.cdc.gov/cancer/nbccedp/about.htm. Accessed October 1, 2005.
Kinman EL. Evaluating health service equity at a primary care clinic in Chilimarca, Bolivia. Soc Sci Med. 1999;49(5):663–678.
Talen E. School, community, and spatial equity: an empirical investigation of access to elementary schools in West Virginia. Annals of the Association of American Geographers. 2001;91(3):465–486.
Jargowsky P. Stunning Progress, Hidden Problems: The Dramatic Decline of Concentrated Poverty in the 1990s. Washington, District of Columbia: the Brookings Institution; May 2003. Available at: http://www.brookings.edu/es/urban/publications/jargowskypoverty.pdf. Accessed June 24, 2005.
Guagliardo MF, Ronzio CR, Cheung I, Chacko E, Joseph JG. Physician accessibility: an urban case study of pediatric providers. Health Place. 2004;10(3):273–283.
Abramson AJ, Tobin MS, VanderGoot MR. The changing geography of metropolitan opportunity: the segregation of the poor in U.S. metropolitan areas, 1970 to 1990. Housing Policy Debate. 1995;6(1):45–72.
Iceland J, Weinberg DH, Steinmetz E. Racial and Ethnic Residential Segregation in the United States: 1980–2000. Washington, District of Columbia: USA Government Printing Office; 2002. U.S. Census Bureau Series CENSR-3. Available at: http://www.census.gov/population/www/cen2000/briefs.html.
Sampson RJ, Morenoff JD, Earls F. Beyond social capital: spatial dynamics of collective efficacy for children. Am Soc Rev. 1999;64(633–660).
ArcView [computer program]. Version 3.3. Redlands, California: Environmental Systems Research Institute;1999–2002.
2003 TIGER/Line® Files [database online]. U.S. Census Bureau; 5 Mar 2004. Available at: http://www.census.gov/geo/www/tiger/. Accessed April 7, 2004.
Handy SL, Niemeier DA. Measuring accessibility: an exploration of issues and alternatives. Environment and Planning A. 1997;29:1175–1194.
Talen E. Neighborhoods as service providers: a methodology for evaluating pedestrian access. Environment and Planning B. 2003;30:181–200.
Accessibility Measures (script for use with ArcGIS Desktop) [computer program].Mar 2004. Available at: http://arcscripts.esri.com/.
ArcGIS Desktop [computer program]. Version 8.3. Redlands, California: Environmental Systems Research Institute;1999–2002.
Snap and Split Program [computer program].Dec 2003. Available at: http://arcscripts.esri.com/.
Chicago Transportation Authority CTA Trip Planner [interactive program online]. Available at: http://www.yourcta.com/maps/tripplanner.html. Accessed March 29, 2005.
Chicago Area Transportation Study. Conformity Analysis Documentation Appendix B: Travel Demand Modeling for the Conformity Process in Northeastern Illinois [documentation online]. Chicago Area Transportation Study; Aug 2003. Available at: http://www.catsmpo.com/prog/conformity/prog-conformity-appendixB.pdf. Accessed July 7, 2005.
US Census Bureau. Census 2000 Summary File 3 (SF 3)—Sample Data [database online]. Available: http://factfinder.census.gov/home/saff/main.html?_lang=en. Washington,DC: US Census Bureau; 2005.
Vasiliev IR. Visualization of spatial dependence: an elementary view of spatial autocorrelation. In: Arlinghaus SL, Griffith DA, Arlinghaus WC, Drake WD, Nysteun JD, eds. Practical Handbook of Spatial Statistics. Boca Raton, Florida: CRC; 1995:17–30.
Anselin L. Lagrange multiplier test diagnostics for spatial dependence and spatial heterogeneity. Geographical Analysis. 1988;20:1–17.
Anselin L. Spatial Econometrics: Methods and Models. Boston, Massachusetts: Kluwer Academic; 1988.
Hilkevitch J. CTA ride not worth fare in poorer areas, study says. Chicago Tribune. November 22, 2004:Page 1.
McLafferty S. Urban structure and geographical access to public services. Annals of the Association of American Geographers. 1982;72(3):347–354.
Shen Q. Location characteristics of inner-city neighborhoods and employment accessibility of low-wage workers. Environment and Planning A. 1998;25:345–365.
Luo W, Wang FH. Measures of spatial accessibility to health care in a GIS environment: synthesis and a case study in the Chicago region. Environment and Planning B. 2003;30(6):865–884.
McLafferty S, Grady S. Immigration and geographic access to prenatal clinics in Brooklyn, NY: a geographic information systems analysis. Am J Public Health. 2005;95(4):638–640.
Hyndman JC, D'Arcy C, Holman J, Pritchard DA. The influence of attractiveness factors and distance to general practice surgeries by level of social disadvantage and global access in Perth, Western Australia. Soc Sci Med. 2003;56(2):387–403.
Hyndman JC, Holman CD. Accessibility and spatial distribution of general practice services in an Australian city by levels of social disadvantage. Soc Sci Med. 2001;53(12):1599–1609.
LaVeist TA, Wallace JM. Health risk and inequitable distribution of liquor stores in African American neighborhoods. Soc Sci Med. 2000;51:613–617.
Zenk SN, Schulz AJ, Israel BA, James SA, Bao S, Wilson ML. Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. Am J Public Health. 2005;95:660–667.
Acknowledgement
We would like to thank investigators at the University of Illinois at Chicago Center for Population Health and Health Disparities (5P50CA106743-02), especially Richard B. Warnecke, Richard T. Campbell, and Michael Berbaum, for helpful feedback on the analysis and manuscript. We also wish to thank Claire Bozic for providing and assisting us in using the automobile travel time data from the Chicago Area Transportation Study. This research was supported by: National Cancer Institute Cancer Education and Career Development Program # 5 R25T CA57699-12 (SNZ), The Health Services Research and Development Service Postdoctoral Fellowship Program of the Veterans Health Administration (ET), and the National Cancer Institute (5P50CA106743-02).
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Zenk is with the Program in Cancer Control and Population Sciences, University of Illinois at Chicago, Chicago, IL 60608, USA; Tarlov is with the Midwest Center for Health Services and Policy Research, Hines VA Hospital, USA; Sun is with the Department of Sociology and Criminal Justice, Texas A&M University-Commerce, USA.
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Zenk, S.N., Tarlov, E. & Sun, J. Spatial Equity in Facilities Providing Low- or No-Fee Screening Mammography in Chicago Neighborhoods. JURH 83, 195–210 (2006). https://doi.org/10.1007/s11524-005-9023-4
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DOI: https://doi.org/10.1007/s11524-005-9023-4