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Spatial Equity in Facilities Providing Low- or No-Fee Screening Mammography in Chicago Neighborhoods

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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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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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Correspondence to Shannon N. Zenk.

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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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