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Allen-Valley A, Bains S, Rai K, Summan N, Eleid M, Buajitti E, Rosella LC. Integrating equity indicators for hospital reporting metrics. RESEARCH IN HEALTH SERVICES & REGIONS 2024; 3:10. [PMID: 39177704 PMCID: PMC11281735 DOI: 10.1007/s43999-024-00046-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/20/2024] [Indexed: 08/24/2024]
Abstract
Disparities in healthcare delivery and design are deeply-rooted within healthcare systems globally. Many researchers have developed methods to measure inequity; however, there currently exists no accepted measurement approach implemented consistently across health systems. We applied the model-based Relative Index of Inequality (RII) as a measure of inequity at one of Canada's largest health systems, Trillium Health Partners, across two service types: planned and outpatient. Our RII estimates suggest that the lowest-SES individuals received planned and outpatient services at rates 2.4 times and 2.5 times lower than the highest-SES individuals, respectively. Across both service types, the largest disparity was for breast cancer screening, where patients from the lowest-SES neighbourhoods were 5.4 times less likely to use this service at THP. These findings further underscore the importance of consistently measuring and monitoring inequities to develop effective strategies to address the health needs of patients from lower SES neighbourhoods. The approach used within this study should be considered for widespread integration into health system reporting metrics.
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Affiliation(s)
- Aliya Allen-Valley
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Shalu Bains
- Trillium Health Partners, Mississauga, ON, Canada
| | - Karen Rai
- Trillium Health Partners, Mississauga, ON, Canada
| | | | - May Eleid
- Trillium Health Partners, Mississauga, ON, Canada
| | - Emmalin Buajitti
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Laura C Rosella
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Peptenatu D, Nedelcu ID, Pop CS, Simion AG, Furtunescu F, Burcea M, Andronache I, Radulovic M, Jelinek HF, Ahammer H, Gruia AK, Grecu A, Popa MC, Militaru V, Drăghici CC, Pintilii RD. The Spatial-Temporal Dimension of Oncological Prevalence and Mortality in Romania. GEOHEALTH 2023; 7:e2023GH000901. [PMID: 37799773 PMCID: PMC10549965 DOI: 10.1029/2023gh000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/18/2023] [Accepted: 08/27/2023] [Indexed: 10/07/2023]
Abstract
The objective of this study was to identify spatial disparities in the distribution of cancer hotspots within Romania. Additionally, the research aimed to track prevailing trends in cancer prevalence and mortality according to a cancer type. The study covered the timeframe between 2008 and 2017, examining all 3,181 territorial administrative units. The analysis of spatial distribution relied on two key parameters. The first parameter, persistence, measured the duration for which cancer prevalence exceeded the 75th percentile threshold. Cancer prevalence refers to the total number of individuals in a population who have been diagnosed with cancer at a specific time point, including both newly diagnosed cases (occurrence) and existing cases. The second parameter, the time continuity of persistence, calculated the consecutive months during which cancer prevalence consistently surpassed the 75th percentile threshold. Notably, persistence of elevated values was also evident in lowland regions, devoid of any discernible direct connection to environmental conditions. In conclusion, this work bears substantial relevance to regional health policies, by aiding in the formulation of prevention strategies, while also fostering a deeper comprehension of the socioeconomic and environmental factors contributing to cancer.
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Affiliation(s)
- D. Peptenatu
- Research Center for Integrated Analysis and Territorial Management—CAIMTFaculty of GeographyUniversity of BucharestBucharestRomania
| | - I. D. Nedelcu
- Research Center for Integrated Analysis and Territorial Management—CAIMTFaculty of GeographyUniversity of BucharestBucharestRomania
| | - C. S. Pop
- Carol Davila University of Medicine and PharmacyBucharestRomania
| | - A. G. Simion
- Research Center for Integrated Analysis and Territorial Management—CAIMTFaculty of GeographyUniversity of BucharestBucharestRomania
| | - F. Furtunescu
- Carol Davila University of Medicine and PharmacyBucharestRomania
| | - M. Burcea
- Faculty of Administration and BusinessUniversity of BucharestBucharestRomania
| | - I. Andronache
- Research Center for Integrated Analysis and Territorial Management—CAIMTFaculty of GeographyUniversity of BucharestBucharestRomania
| | - M. Radulovic
- Department of Experimental OncologyInstitute of Oncology and Radiology of SerbiaBelgradeSerbia
| | - H. F. Jelinek
- Department of Biomedical Engineering and Healthcare Engineering Innovation CenterKhalifa UniversityAbu DhabiUnited Arab Emirates
| | - H. Ahammer
- Division of Medical Physics and BiophysicsGSRCMedical University of GrazGrazAustria
| | - A. K. Gruia
- Faculty of Administration and BusinessUniversity of BucharestBucharestRomania
| | - A. Grecu
- Faculty of Administration and BusinessUniversity of BucharestBucharestRomania
| | - M. C. Popa
- Research Center for Integrated Analysis and Territorial Management—CAIMTFaculty of GeographyUniversity of BucharestBucharestRomania
| | - V. Militaru
- Faculty of MedicineIuliu Haţieganu University of Medicine and Pharmacy Cluj‐NapocaCluj‐NapocaRomania
| | - C. C. Drăghici
- Research Center for Integrated Analysis and Territorial Management—CAIMTFaculty of GeographyUniversity of BucharestBucharestRomania
| | - R. D. Pintilii
- Research Center for Integrated Analysis and Territorial Management—CAIMTFaculty of GeographyUniversity of BucharestBucharestRomania
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Lee J, Ewing B, Holmes D. Barriers and Facilitators to Colorectal Cancer Screening in South Asian Immigrants: A Systematic Review. Asian Pac J Cancer Prev 2023; 24:1463-1475. [PMID: 37247265 PMCID: PMC10495916 DOI: 10.31557/apjcp.2023.24.5.1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/22/2023] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE The purpose of this systematic review is to broaden our knowledge of colorectal cancer (CRC) screening in South Asian immigrants living in Canada, Hong Kong, the United Kingdom, the United States, and Australia by determining the barriers and facilitators and examining interventions for CRC screening. METHODS A literature search of PubMed, Ovid Medline, and Google was conducted using South Asian, Asian Indians, cancer screening, colorectal neoplasm, early detection of cancer, and mass screening as search terms. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only research articles written in English from 2000 to July 2022 were collected. Inclusion criteria included all English-language articles, the South Asian population, and either reporting barriers, facilitators, interventions, or recommendations for CRC screening. Exclusion criteria included all articles that did not meet inclusion criteria or were duplicates. A total of 32 articles were deemed eligible for inclusion and were retrieved for further analysis. The countries of origin in the articles reviewed included Canada, Hong Kong, the United Kingdom, the United States, and Australia. RESULTS In general, the studies indicated that South Asians have low CRC screening rates. The most common barriers reported were poor knowledge/awareness of CRC and CRC screening, lack of physician recommendation, psychological factors (e.g., fear, anxiety, and shame), cultural/religious factors, and sociodemographic factors (language barrier, lower income, and female gender). The most important facilitator reported was the physician's recommendation. Six intervention studies of either education or organized screening programs were shown to have a positive influence by increasing knowledge and improving attitudes toward CRC screening. CONCLUSION Of the limited number of studies identified, the population categorized as South Asians was largely heterogeneous, including a diversity of ethnicities. Although the rates of CRC among South Asians were relatively low, there remain many cultural barriers to the awareness of and screening for CRC in this population. Further research in this population is needed to better identify the factors related to CRC in individuals of South Asian ethnicity. Recommending CRC screening by physicians and mid-level providers and educating patients with culturally sensitive programs and materials are important to increase knowledge and awareness of CRC and CRC screening.
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Affiliation(s)
- James Lee
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA.
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Simkin J, Dummer TJB, Erickson AC, Otterstatter MC, Woods RR, Ogilvie G. Small area disease mapping of cancer incidence in British Columbia using Bayesian spatial models and the smallareamapp R Package. Front Oncol 2022; 12:833265. [PMID: 36338766 PMCID: PMC9627310 DOI: 10.3389/fonc.2022.833265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 09/26/2022] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION There is an increasing interest in small area analyses in cancer surveillance; however, technical capacity is limited and accessible analytical approaches remain to be determined. This study demonstrates an accessible approach for small area cancer risk estimation using Bayesian hierarchical models and data visualization through the smallareamapp R package. MATERIALS AND METHODS Incident lung (N = 26,448), female breast (N = 28,466), cervical (N = 1,478), and colorectal (N = 25,457) cancers diagnosed among British Columbia (BC) residents between 2011 and 2018 were obtained from the BC Cancer Registry. Indirect age-standardization was used to derive age-adjusted expected counts and standardized incidence ratios (SIRs) relative to provincial rates. Moran's I was used to assess the strength and direction of spatial autocorrelation. A modified Besag, York and Mollie model (BYM2) was used for model incidence counts to calculate posterior median relative risks (RR) by Community Health Service Areas (CHSA; N = 218), adjusting for spatial dependencies. Integrated Nested Laplace Approximation (INLA) was used for Bayesian model implementation. Areas with exceedance probabilities (above a threshold RR = 1.1) greater or equal to 80% were considered to have an elevated risk. The posterior median and 95% credible intervals (CrI) for the spatially structured effect were reported. Predictive posterior checks were conducted through predictive integral transformation values and observed versus fitted values. RESULTS The proportion of variance in the RR explained by a spatial effect ranged from 4.4% (male colorectal) to 19.2% (female breast). Lung cancer showed the greatest number of CHSAs with elevated risk (Nwomen = 50/218, Nmen = 44/218), representing 2357 total excess cases. The largest lung cancer RRs were 1.67 (95% CrI = 1.06-2.50; exceedance probability = 96%; cases = 13) among women and 2.49 (95% CrI = 2.14-2.88; exceedance probability = 100%; cases = 174) among men. Areas with small population sizes and extreme SIRs were generally smoothed towards the null (RR = 1.0). DISCUSSION We present a ready-to-use approach for small area cancer risk estimation and disease mapping using BYM2 and exceedance probabilities. We developed the smallareamapp R package, which provides a user-friendly interface through an R-Shiny application, for epidemiologists and surveillance experts to examine geographic variation in risk. These methods and tools can be used to estimate risk, generate hypotheses, and examine ecologic associations while adjusting for spatial dependency.
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Affiliation(s)
- Jonathan Simkin
- Cancer Control Research, BC Cancer, Provincial Health Services Authority, Vancouver, BC, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Trevor J. B. Dummer
- Cancer Control Research, BC Cancer, Provincial Health Services Authority, Vancouver, BC, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anders C. Erickson
- Office of the Provincial Health Officer, Government of British Columbia, Victoria, BC, Canada
| | - Michael C. Otterstatter
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Ryan R. Woods
- Cancer Control Research, BC Cancer, Provincial Health Services Authority, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Gina Ogilvie
- Cancer Control Research, BC Cancer, Provincial Health Services Authority, Vancouver, BC, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Women’s Health Research Institute, BC Women’s Hospital + Health Centre, Vancouver, BC, Canada
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Kazi E, Sareshwala S, Ansari Z, Sahota D, Katyal T, Tseng W, Ivey SL. Promoting Colorectal Cancer Screening in South Asian Muslims Living in the USA. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:865-873. [PMID: 32279246 DOI: 10.1007/s13187-020-01715-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Colorectal cancer is one of the more common forms of cancer in South Asian men and women. Despite the rates of colorectal cancer (CRC) in South Asians, the CRC screening rates remain low in South Asians and Muslims compared with those in Whites and other ethnic minorities in the USA. Religious and cultural barriers have been examined in relation to other types of cancer such as breast and cervical cancers. However, few data are available about CRC screening among Muslims, particularly South Asian American Muslims. A community-based participatory research approach was used to assess attitudes toward CRC screening and various cultural, religious, and gender barriers that prevent CRC screening expressed by Muslim South Asian men and women in the larger San Francisco Bay Area. Six focus groups were conducted (three males and three females) with South Asian American Muslims. The focus groups consisted of a total sample size of n = 32, with 15 men and 17 women, with the average age of participants being 57 years old. This study highlighted key religious, cultural, and gender barriers to CRC screening including lack of awareness of CRC, the notion of fatalism as it relates to screening, lack of emphasis on preventive health, the need to preserve modesty, and stigma around certain CRC screening practices. Religiously tailored interventions and culturally sensitive healthcare providers are needed to better promote CRC screening in South Asian Muslim communities and to help inform the design of health interventions and outreach strategies.
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Affiliation(s)
- Eiman Kazi
- University of California, Berkeley, 2199 Addison Street, 4th floor, Berkeley, CA, 94720, USA.
| | | | - Zahra Ansari
- University of California, Berkeley, 2199 Addison Street, 4th floor, Berkeley, CA, 94720, USA
| | - Dilpreet Sahota
- University of California, Berkeley, 2199 Addison Street, 4th floor, Berkeley, CA, 94720, USA
| | - Toshali Katyal
- University of California, Berkeley, 2199 Addison Street, 4th floor, Berkeley, CA, 94720, USA
| | - Winston Tseng
- University of California, Berkeley, 2199 Addison Street, 4th floor, Berkeley, CA, 94720, USA
| | - Susan L Ivey
- University of California, Berkeley, 2199 Addison Street, 4th floor, Berkeley, CA, 94720, USA
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Fang CY, Ragin CC. Addressing Disparities in Cancer Screening among U.S. Immigrants: Progress and Opportunities. Cancer Prev Res (Phila) 2021; 13:253-260. [PMID: 32132119 DOI: 10.1158/1940-6207.capr-19-0249] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/08/2019] [Accepted: 10/10/2019] [Indexed: 01/04/2023]
Abstract
The United States is home to 47 million foreign-born individuals, which currently represents over 14% of the U.S. population. With greater length of U.S. residence, immigrants experience increased risk for chronic disease including selected cancers; yet, they are less likely to access preventive health care services and undergo cancer screening. As a result, there have been concerted efforts to address disparities in cancer screening in immigrant populations. This minireview describes current progress in promoting participation in cancer screening among U.S. immigrants and explores potential opportunities for improving impact. Of the 42 studies included in the review, the majority targeted Asian and Latino immigrant populations and included some form of culturally specific educational programming, often delivered in-person by community health workers and/or using a multimedia format. Twenty-eight of the 42 studies also offered navigation assistance to help overcome logistical and access barriers to care, and these studies yielded somewhat greater increases in screening. Yet, despite considerable effort over the past 20+ years, screening rates remain well below national goals. Opportunities to harness digital health tools to increase awareness and engagement, evaluating nonclinic-based screening paradigms to promote greater participation, and increasing efforts to address the needs of other immigrant subgroups are likely to have beneficial outcomes. Together, these strategies may help reduce inequities in access and uptake of cancer screening in U.S. immigrant populations.See all articles in this Special Collection Honoring Paul F. Engstrom, MD, Champion of Cancer Prevention.
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Affiliation(s)
- Carolyn Y Fang
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
| | - Camille C Ragin
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Eberth JM, Zahnd WE, Josey MJ, Schootman M, Hung P, Probst JC. Trends in spatial access to colonoscopy in South Carolina, 2000-2014. Spat Spatiotemporal Epidemiol 2021; 37:100414. [PMID: 33980409 DOI: 10.1016/j.sste.2021.100414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/28/2021] [Accepted: 03/01/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Colonoscopy use has increased since Medicare began covering screening for average-risk persons. Our objective was to describe changes in spatial access to colonoscopy in South Carolina (SC) between 2000 and 2014. METHODS Using data from the SC Ambulatory Surgery Database, we created annual ZIP Code Tabulation Area (ZCTA) spatial accessibility scores. We assessed changes in accessibility, colonoscopy supply, and potential demand, overall and by metropolitan designation. Spatial clustering was also explored. RESULTS Spatial accessibility decreased across both small rural and metropolitan ZCTAs but was significantly higher in metropolitan areas during the first part of the study period . The proportion of persons with no access to colonoscopy within 30 min increased over time but was consistently higher in small rural areas. Clusters of low accessibility grew over time. CONCLUSIONS The supply of colonoscopy facilities decreased relative to the potential demand, and clusters of low access increased, indicating a contraction of services.
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Affiliation(s)
- Jan M Eberth
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA; Department of Epidemiology and Biostatistics, University of South Carolina, SC, USA; Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.
| | - Whitney E Zahnd
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA
| | - Michele J Josey
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA; Department of Epidemiology and Biostatistics, University of South Carolina, SC, USA; Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
| | - Mario Schootman
- Department of Clinical Analytics, SSM Health, Saint Louis, MO, USA
| | - Peiyin Hung
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA
| | - Janice C Probst
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA; Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA
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Ranganathan R, Zahnd WE, Harrison SE, Brandt HM, Adams SA, Eberth JM. Spatial Access to Vaccines for Children Providers in South Carolina: Implications for HPV Vaccination. Prev Chronic Dis 2020; 17:E163. [PMID: 33357307 PMCID: PMC7784554 DOI: 10.5888/pcd17.200300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Radhika Ranganathan
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Big Data Health Science Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Dr, Ste 204, Columbia, SC 29210.
| | - Sayward E Harrison
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, South Carolina.,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Heather M Brandt
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina
| | - Swann Arp Adams
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina.,College of Nursing, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Big Data Health Science Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Montazeri M, Hoseini B, Firouraghi N, Kiani F, Raouf-Mobini H, Biabangard A, Dadashi A, Zolfaghari V, Ahmadian L, Eslami S, Bergquist R, Bagheri N, Kiani B. Spatio-temporal mapping of breast and prostate cancers in South Iran from 2014 to 2017. BMC Cancer 2020; 20:1170. [PMID: 33256668 PMCID: PMC7708260 DOI: 10.1186/s12885-020-07674-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background The most common gender-specific malignancies are cancers of the breast and the prostate. In developing countries, cancer screening of all at risk is impractical because of healthcare resource limitations. Thus, determining high-risk areas might be an important first screening step. This study explores incidence patterns of potential high-risk clusters of breast and prostate cancers in southern Iran. Methods This cross-sectional study was conducted in the province of Kerman, South Iran. Patient data were aggregated at the county and district levels calculating the incidence rate per 100,000 people both for cancers of the breast and the prostate. We used the natural-break classification with five classes to produce descriptive maps. A spatial clustering analysis (Anselin Local Moran’s I) was used to identify potential clusters and outliers in the pattern of these cancers from 2014 to 2017. Results There were 1350 breast cancer patients (including, 42 male cases) and 478 prostate cancer patients in the province of Kerman, Iran during the study period. After 45 years of age, the number of men with diagnosed prostate cancer increased similarly to that of breast cancer for women after 25 years of age. The age-standardised incidence rate of breast cancer for women showed an increase from 29.93 to 32.27 cases per 100,000 people and that of prostate cancer from 13.93 to 15.47 cases per 100,000 during 2014–2017. Cluster analysis at the county level identified high-high clusters of breast cancer in the north-western part of the province for all years studied, but the analysis at the district level showed high-high clusters for only two of the years. With regard to prostate cancer, cluster analysis at the county and district levels identified high-high clusters in this area of the province for two of the study years. Conclusions North-western Kerman had a significantly higher incidence rate of both breast and prostate cancer than the average, which should help in designing tailored screening and surveillance systems. Furthermore, this study generates new hypotheses regarding the potential relationship between increased incidence of cancers in certain geographical areas and environmental risk factors. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-020-07674-8.
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Affiliation(s)
- Mahdieh Montazeri
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Health Information Technology, School of Management and Medical Information Science, Kerman University of Medical Sciences, Kerman, Iran
| | - Benyamin Hoseini
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Health Information Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Neda Firouraghi
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Kiani
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hosein Raouf-Mobini
- Department of Health Information Technology, Faculty of Paramedicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Adele Biabangard
- Department of Health Information Technology, Faculty of Paramedicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Ali Dadashi
- Medical Records Department, Vali-e-asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Vahideh Zolfaghari
- Department of Medical Educational Technology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Ahmadian
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Saeid Eslami
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robert Bergquist
- Ingerod, SE-454 94 Brastad, Sweden. Formerly UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Nasser Bagheri
- Visualisation and Decision Analytics (VIDEA) Lab, Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Behzad Kiani
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Bamimore MA, Devlin RA, Zaric GS, Garg AX, Sarma S. Quality of Diabetes Care in Blended Fee-for-Service and Blended Capitation Payment Systems. Can J Diabetes 2020; 45:261-268.e11. [PMID: 33162371 DOI: 10.1016/j.jcjd.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES In the middle to late 2000s, many family physicians switched from a Family Health Group (FHG; a blended fee-for-service model) to a Family Health Organization (FHO; a blended capitation model) in Ontario, Canada. The evidence on the link between physician remuneration schemes and quality of diabetes care is mixed in the literature. We examined whether physicians who switched from the FHG to FHO model provided better care for individuals living with diabetes relative to those who remained in the FHG model. METHODS Using longitudinal health administrative data from 2006 to 2016, we investigated the impact of physicians switching from FHG to FHO on 8 quality indicators related to diabetes care. Because FHO physicians are likely to be systematically different from FHGs, we employed propensity-score-based inverse probability-weighted fixed-effects regression models. All analyses were conducted at the physician level. RESULTS We found that FHO physicians were more likely to provide glycated hemoglobin testing by 2.75% (95% confidence interval [CI], 1.89% to 3.60%), lipid assessment by 2.76% (CI, 1.95% to 3.57%), nephropathy screening by 1.08% (95% CI, 0.51% to 1.66%) and statin prescription by 1.08% (95% CI, 0.51% to 1.66%). Patients under FHOs had a lower estimated risk of mortality by 0.0124% (95% CI, 0.0123% to 0.0126%) per physician per year. However, FHG and FHO physicians were similar for annual eye examination, prescription of angiotensin-converting enzyme inhibitors (or angiotensin II receptor blockers) and patients' risk of avoidable diabetes-related hospitalizations. CONCLUSIONS Compared with blended fee-for-service, blended capitation payment is associated with a small, but statistically significant, improvement in some aspects of diabetes care.
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Affiliation(s)
- Mary Aderayo Bamimore
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Rose Anne Devlin
- Department of Economics, University of Ottawa, Ottawa, Ontario, Canada
| | - Gregory S Zaric
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada; Ivey Business School, Western University, London, Ontario, Canada
| | - Amit X Garg
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Sisira Sarma
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
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Wan Z, Wang Y, Deng C. Application of GIS Spatial Analysis and Scanning Statistics in the Gynecological Cancer Clustering Pattern and Risk Screening: A Case Study in Northern Jiangxi Province, China. Risk Manag Healthc Policy 2020; 13:1079-1093. [PMID: 32982504 PMCID: PMC7493024 DOI: 10.2147/rmhp.s261221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/28/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The incidence of gynecological cancer is high in China, and the effects of related treatments and preventive measures need to be improved. METHODS This study uses GIS spatial analysis methods and a scanning statistical analysis to study the major gynecological cancers in northern Jiangxi Province from 2016 to 2018. RESULTS The incidence and spatial pattern of cervical cancer, ovarian cancer, and uterine cancer had agglomeration characteristics and changes during the study period. The gynecological cancer had a spatial autocorrelation and agglomeration in its spatial pattern. The Moran's Index of the overall gynecological cancer incidence rate was 0.289 (p = 0.005). Ripley's L(d) function showed that the agglomeration radius was between 51.40 and 52.82 km. The results of the kernel density estimation showed that the cases of gynecological cancer were concentrated in the central and northeastern areas of the study area. The overall county-level incidence of gynecological cancer varied from 0.26 to 11.14 per 100,000. The results of the gravity center analysis showed that the spatial distribution of the gravity center point of gynecological cancer had moved toward the east during the past three years. The results of a hotspot analysis showed that there were five hotspot areas that had gynecological cancers. The most likely clusters of gynecological cancer at the county level in northern Jiangxi Province were distributed in the adjacent areas of Jiujiang, Yichun, and Nanchang, with a relative risk of 1.85. CONCLUSION The research shows that GIS can display the distribution of cancer cases and can use spatial analysis methods and scanning statistical techniques to obtain key areas of cancer incidence. These results can provide data and key areas for the formulation of regional public health policies and provide recommendations for cancer screening and the rational allocation of health resources.
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Affiliation(s)
- Zhiwei Wan
- School of Geography and Environment, Jiangxi Normal University, Nanchang330022, People’s Republic of China
| | - Yaqi Wang
- Jiangxi Provincial Cancer Center, Jiangxi Provincial Cancer Hospital, Nanchang330029, People’s Republic of China
| | - Chunhong Deng
- Jiangxi Provincial Cancer Center, Jiangxi Provincial Cancer Hospital, Nanchang330029, People’s Republic of China
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Simkin J, Erickson AC, Otterstatter MC, Dummer TJB, Ogilvie G. Current State of Geospatial Methodologic Approaches in Canadian Population Oncology Research. Cancer Epidemiol Biomarkers Prev 2020; 29:1294-1303. [PMID: 32299848 DOI: 10.1158/1055-9965.epi-20-0092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/25/2020] [Accepted: 04/10/2020] [Indexed: 11/16/2022] Open
Abstract
Geospatial analyses are increasingly used in population oncology. We provide a first review of geospatial analysis in Canadian population oncology research, compare to international peers, and identify future directions. Geospatial-focused peer-reviewed publications from 1992-2020 were compiled using PubMed, MEDLINE, Web of Science, and Google Scholar. Abstracts were screened for data derived from a Canadian cancer registry and use of geographic information systems. Studies were classified by geospatial methodology, geospatial unit, location, cancer site, and study year. Common limitations were documented from article discussion sections. Our search identified 71 publications using data from all provincial and national cancer registries. Thirty-nine percent (N = 28) were published in the most recent 5-year period (2016-2020). Geospatial methodologies included exposure assessment (32.4%), identifying spatial associations (21.1%), proximity analysis (16.9%), cluster detection (15.5%), and descriptive mapping (14.1%). Common limitations included confounding, ecologic fallacy, not accounting for residential mobility, and small case/population sizes. Geospatial analyses are increasingly used in Canadian population oncology; however, efforts are concentrated among a few provinces and common cancer sites, and data are over a decade old. Limitations were similar to those documented internationally, and more work is needed to address them. Organized efforts are needed to identify common challenges, develop leading practices, and identify shared priorities.
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Affiliation(s)
- Jonathan Simkin
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. .,BC Cancer, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Anders C Erickson
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Office of the Provincial Health Officer, Government of British Columbia, Victoria, British Columbia, Canada
| | - Michael C Otterstatter
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Trevor J B Dummer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,BC Cancer, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,BC Cancer, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada.,BC Centre for Disease Control, Vancouver, British Columbia, Canada
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13
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Crawford J, Morfaw F, Ahmad F, Thabane L, Frisina A. The colon cancer screening behaviours survey for South Asians: a pilot study of feasibility and psychometric evaluation. J Patient Rep Outcomes 2020; 4:12. [PMID: 32056042 PMCID: PMC7064674 DOI: 10.1186/s41687-019-0160-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/08/2019] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The purpose of the study was to pilot test the English and Urdu version of the Colon Cancer Screening Behaviours Survey among South Asians in Canada. The first objective was to evaluate feasibility of administration, data collection using computer assisted personal interviewing software on a tablet, and response burden. The second objective was to examine the prevalence of colorectal cancer screening among South Asians and evaluate the psychometric properties of sub-scales in the survey. METHODS Purposive, network and snowball sampling were used to recruit participants for this cross-sectional study. Interviewer-led administration of the Colon Cancer Screening Behaviours Survey was conducted across two cities in Ontario, Canada. Qualitative data analysis assessed feasibility; and sub-scales were evaluated through principal component analysis, item-scale correlations, and construct validity using multiple linear and logistic regression. RESULTS A total of 328 South Asians participated, 47% Urdu speaking, and 53% English speaking. There was a 23% refusal rate to participate. Feasibility identified: (1) successful recruitment despite reasons for refusal; (2) problematic items and response categories; and (3) computer/tablet limitations. Principal component analysis identified 14 components that explained 68.7% of total variance; 34 items were retained after factor analysis. Internal consistency of 4 scales ranged from 0.79-0.91. There were significant differences in perceived barriers scale scores (- 12.21; 95% CI, - 17.13 to - 7.28; p < 0.0001) between those who participated and those who did not participate in screening. No association was found with years of residence and uptake of screening after adjustment (OR 0.91 (0.46-1.79), p = 0.783). CONCLUSIONS Recruitment and data collection methods are feasible among South Asians if functionality of the tablet selected is improved. The Colon Cancer Screening Behaviours Survey was finalized and retained items in sub-scales demonstrated good psychometric properties to assess behaviours for colon cancer screening among South Asians in Canada. The interviewer-led survey may be used by public health, cancer care or other health practitioners to describe or predict colorectal cancer screening behaviours among South Asians in similar settings or adapted and tested in other contexts.
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Affiliation(s)
- Joanne Crawford
- Faculty of Applied Health Sciences, Department of Nursing, Brock University, St. Catharines, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1 Canada
| | - Frederick Morfaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada
| | - Farah Ahmad
- School of Health Policy & Management, York University, Toronto, ON Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada
| | - Angela Frisina
- School of Nursing, McMaster University, Hamilton, ON Canada
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14
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Honiball NM, Marcus TS. The use and value of maps in Community-Oriented Primary Care: Does process matter? Afr J Prim Health Care Fam Med 2020; 12:e1-e9. [PMID: 32129652 PMCID: PMC7061222 DOI: 10.4102/phcfm.v12i1.2099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/17/2019] [Accepted: 06/29/2019] [Indexed: 12/01/2022] Open
Abstract
Background Maps are important tools in healthcare delivery. In Community-Oriented Primary Care (COPC), they are expected to be used to plan services and resources for defined geographical areas, delineate team practice areas, allocate healthcare workers to households and support service delivery and performance management. Aim This is a study of the use and value of maps and mapmaking in the delivery of healthcare services through Ward-Based Outreach Teams (WBOTs). Setting This study was conducted between 2014 and 2016 in Mamelodi (South Africa), an urban settlement selected to begin the City of Tshwane’s WBOT implementation programme in 2013. Methods This study is based on three qualitative participatory mapmaking projects with WBOT healthcare professionals and workers. Data generated through mapmaking, focused group discussions, individual semi-structured interviews, reflective writing and feedback workshops were analysed thematically. Results Through mapmaking and discussions about the maps, healthcare providers took ownership of the maps they were creating or viewing, added their own information onto the maps, voiced issues about their practice, generated new knowledge and shared ideas and solutions for challenges. These processes expanded the use and value of maps beyond assisting participants to gain insights into the context, people and organisations of their places of work. Conclusion Maps become creative learning tools that can be used in emergent ways to solve healthcare service and other problems when they are actively generated and engaged through facilitated discussion and reflection. This allows WBOTs to see maps as dynamic canvasses that they can use to improve service delivery.
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Affiliation(s)
- Nina M Honiball
- School of the Arts, Faculty of Humanities, University of Pretoria, Pretoria.
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15
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Biesecker C, Zahnd WE, Brandt HM, Adams SA, Eberth JM. A Bivariate Mapping Tutorial for Cancer Control Resource Allocation Decisions and Interventions. Prev Chronic Dis 2020; 17:E01. [PMID: 31895673 PMCID: PMC6977777 DOI: 10.5888/pcd17.190254] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Bivariate choropleth mapping is a straightforward but underused method for displaying geographic health information to use in public health decision making. Previous studies have recommended this approach for state comprehensive cancer control planning and similar efforts. In this method, 2 area-level variables of interest are mapped simultaneously, often as overlapping quantiles or by using other classification methods. Variables to be mapped may include area-level (eg, county level) measures of disease burden, health care use, access to health care services, and sociodemographic characteristics. We demonstrate how geographic information systems software, specifically ArcGIS, can be used to develop bivariate choropleth maps to inform resource allocation and public health interventions. We used 2 types of county-level public health data: South Carolina’s Behavioral Risk Factor Surveillance System estimates of ever having received cervical cancer screening, and a measure of availability of cervical cancer screening providers that are part of South Carolina’s Breast and Cervical Cancer Early Detection Program. Identification of counties with low screening rates and low access to care may help inform where additional resources should be allocated to improve access and subsequently improve screening rates. Similarly, identifying counties with low screening rates and high access to care may help inform where educational and behavioral interventions should be targeted to improve screening in areas of high access.
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Affiliation(s)
- Claire Biesecker
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Dr, Ste 204, Columbia, SC 29210.
| | - Heather M Brandt
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Swann Arp Adams
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Predictors and Spatial Variation of Radon Testing in Illinois, 2005-2012. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 24:e1-e9. [PMID: 28257398 DOI: 10.1097/phh.0000000000000534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Radon is the second leading cause of lung cancer, but exposure can be reduced through testing one's home and mitigating if levels are high. OBJECTIVE To determine what factors predict radon testing and to identify, through spatial analysis, areas in Illinois with lower or higher than expected testing rates. DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOMES An ecological study design was used to evaluate data on radon tests performed in Illinois by a licensed professional or a home radon test kit analyzed by a state-approved laboratory between 2005 and 2012. Zip code-level rates of testing per 1000 occupied residences were calculated for all testing methods combined and for licensed professional testing and home kit testing separately. The following zip code-level factors associated with radon testing were considered: Environmental Protection Agency (EPA) radon zones (ie, categorization of areas by predicted radon risk), socioeconomic characteristics, homeowner occupancy, and rurality. Univariate and multivariable incidence rate ratios were calculated to examine what factors were associated with each testing type. Hotspot analysis was performed to identify zip codes with lower than expected and higher than expected testing rates (ie, "coldspots" and "hotspots," respectively). RESULTS Radon testing rates varied across EPA zone, socioeconomic characteristics, and level of rurality. In multivariable analysis, EPA zone, education, and median household income positively predicted all testing types combined. Median home value was associated with licensed testing, whereas rurality was negatively associated with licensed testing. Owner occupancy positively predicted home kit testing. Between 19.6% and 31.1% of zip codes were coldspots for radon testing rates, dependent upon testing type. Coldspots of all testing method rates were concentrated in the southern part of the state. CONCLUSION Public health professionals can benefit from understanding what area-level factors predict radon testing and what geographic areas may under-utilize testing. Such information can aid the development of geographically targeted, cost-effective interventions that increase radon testing and subsequently reduce lung cancer risk.
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Padilla CM, Painblanc F, Soler-Michel P, Vieira VM. Mapping Variation in Breast Cancer Screening: Where to Intervene? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2274. [PMID: 31252599 PMCID: PMC6651541 DOI: 10.3390/ijerph16132274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/07/2019] [Accepted: 06/22/2019] [Indexed: 11/24/2022]
Abstract
Small geographic areas with lower mammography screening participation rates may reflect gaps in screening efforts. Our objective was to use spatial analyses to understand disparities in mammography screening use and to identify factors to increase its uptake in areas that need it in Lyon metropolitan area, France. Data for screened women between the ages of 50 and 74 were analyzed. Census blocks of screened and non screened women were extracted from the mammography screening programme 2015-2016 dataset. We used spatial regression models, within a generalized additive framework to determine clusters of census blocks with significantly higher prevalence of non-participation of mammography screening. Smoothed risk maps were crude and adjusted on the following covariates: deprivation index and opportunistic screening. Among 178,002 women aged 50 to 74, 49.9% received mammography screening. As hypothesized, women living in highly deprived census blocks had lower participation rates compared to less deprived blocks, 45.2% vs. 51.4% p < 0.001. Spatial analyses identified four clusters, one located in an urban area and three in suburban areas. Moreover, depending on the location of the cluster, the influence came from different variables. Knowing the impact of site-specific risk factors seems to be important for implementing an appropriate prevention intervention.
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Affiliation(s)
- Cindy M Padilla
- Université Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449 Rennes, France.
| | - François Painblanc
- Université Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449 Rennes, France
| | - Patricia Soler-Michel
- Centre régional de coordination des dépistages des cancers Auvergne Rhône Alpes, 5 bis, rue Cléberg, 69322 Lyon CEDEX 05, France
| | - Veronica M Vieira
- Program in Public Health, University of California, Irvine, CA 92697, USA
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18
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Zahnd WE, McLafferty SL, Sherman RL, Klonoff-Cohen H, Farner S, Rosenblatt KA. Spatial Accessibility to Mammography Services in the Lower Mississippi Delta Region States. J Rural Health 2019; 35:550-559. [PMID: 30690797 DOI: 10.1111/jrh.12349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To characterize spatial access to mammography services across 8 Lower Mississippi Delta Region (LMDR) states. These states include the Delta Region, a federally designated, largely rural, and impoverished region with a high proportion of black residents and low mammography utilization rates. METHODS Using the enhanced 2-step floating catchment area method, we calculated spatial accessibility scores for mammography services across LMDR census tracts. We compared accessibility scores between the Delta and non-Delta Regions of the LMDR. We also performed hotspot analysis and constructed spatial lag models to detect clusters of low spatial access and to identify sociodemographic factors associated with access, respectively. We obtained mammography facility locations data from the Food and Drug Administration and sociodemographic variables from the American Community Survey and the US Department of Agriculture. RESULTS Overall, there were no differences in spatial accessibility scores between the Delta and non-Delta Regions, though there was some state-to-state variation. Clusters of low spatial access were found in parts of the Arkansas, Mississippi, and Tennessee Delta. Spatial lag models found that poverty was associated with greater spatial access to mammography. CONCLUSIONS The lack of identified differences in spatial access to mammography in the Delta and non-Delta Regions suggests that psychosocial or financial barriers play a larger role in lower mammography utilization rates. Identifying clusters of low spatial access to mammography services can help inform resource allocation. Further, our study underscores the value of using coverage-based methods rather than travel time or container measures to evaluate spatial access to care.
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Affiliation(s)
- Whitney E Zahnd
- Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Sara L McLafferty
- Department of Geography and Geographic Information Science, University of Illinois Urbana-Champaign, Urbana, Illinois
| | - Recinda L Sherman
- North American Association of Central Cancer Registries, Springfield, Illinois
| | - Hillary Klonoff-Cohen
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, Illinois
| | - Susan Farner
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, Illinois
| | - Karin A Rosenblatt
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, Illinois
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Deshpande M, Zahnd WE, Bandy L, Lorenson J, Fifer A. Spatial analysis of disparities in asthma treatment among adult asthmatics. Res Social Adm Pharm 2018; 15:1145-1153. [PMID: 30279128 DOI: 10.1016/j.sapharm.2018.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/07/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Spatial analytic techniques can uncover important differences in asthma treatment and identify geographic areas with poor asthma management. OBJECTIVE To review geographical differences in asthma treatment in an adult asthmatic population. METHODS This was a retrospective, cross-sectional chart review study (n = 519) using Geographic Information System approaches to determine the impact of spatial access to pharmacies and other factors on inappropriate rescue and inadequate controller medication use. Statistical analyses included chi-square test for categorical variables and Kruskall-Wallis test for continuous variables. Logistic regression was used to determine unadjusted and adjusted odds of inappropriate and inadequate pharmaceutical management of asthma based upon distance to pharmacy and other factors. Choropleth maps were constructed to display zip code level variation of asthma management. RESULTS Inappropriate medication users lived further from their preferred pharmacy compared to appropriate users (median distances of 3.02 and 1.96 miles respectively; p = 0.01). Inappropriate and inadequate management of asthma varied by zip code, ranging from 5.5 to 17.3% and 25.0-59.6%, respectively. A statistically significant difference in appropriate use by age was found, with nearly 17% of adults age 65 and older overusing their rescue inhaler. Conversely, patients age 18-34 years, 35-49 years, and 50-64 years, used their controller medications inadequately (64.2%, 57.3%, and 48.2%, respectively) compared to 42.5% of patients aged 65 and older. Unadjusted and adjusted analyses showed that former smokers had higher odds of inadequate management of asthma. CONCLUSION The unadjusted findings suggest that distance to pharmacies may play a role in the pharmaceutical management of asthma, though these findings are explained by confounding factors. Future research should continue to explore the effect of spatial access to pharmacies on chronic disease management and the role that maps can play in guiding medication management interventions in a larger sample to allow for more rigorous analysis.
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Affiliation(s)
- Maithili Deshpande
- School of Pharmacy, Southern Illinois University-Edwardsville, United States.
| | - Whitney E Zahnd
- Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - Lindsay Bandy
- School of Pharmacy, Southern Illinois University-Edwardsville, United States
| | | | - Amber Fifer
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL, United States
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Rebolledo EAS, Chiaravalloti F, Giatti LL. [Experiences, benefits and challenges of the use of geoprocessing for the development of primary health careExperiências, benefícios e desafios do uso de geoprocessamento para o desenvolvimento da atenção primária à saúde]. Rev Panam Salud Publica 2018; 42:e153. [PMID: 31093181 PMCID: PMC6386021 DOI: 10.26633/rpsp.2018.153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 08/08/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To review the empirical consequences of the use of geoprocessing in the management of primary health care (PHC) services, in order to disseminate the benefits of this technology and analyze the challenges that must be overcome for its contribution to the development of PHC. Methods A systematic review of primary studies published in Spanish, English or Portuguese between 2000 and 2017 was carried out. First, a review of the academic production was carried out by continent and type of objective. In a second stage, the studies that experimented with and evaluated the use of geoprocessing in empirical form were selected. Specific and generic benefits, as well as limitations, were reviewed. Results 134 articles were identified in the first stage of selection, half of them from the Region of the Americas. Only nine studies met the criteria and were reviewed in the second stage. These studies showed that the use of geoprocessing generates benefits that go beyond the technical benefits, with limitations that can be overcome. Conclusions Although the benefits of using geoprocessing have been widely discussed, few studies have evaluated its implementation in PHC empirically. Practical experiences, which could easily be reproduced in different communities, show that its continued use could increase the capacity to respond to the goals of PHC, as well as to the goals of sustainable development.
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Families with newborns: Using a cartographic model to identify those who are at risk for fires. Burns 2018; 44:1585-1590. [DOI: 10.1016/j.burns.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/17/2018] [Accepted: 02/01/2018] [Indexed: 11/23/2022]
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Crawford J. Promoting colorectal cancer screening among South Asian populations: Strategies to promote access. Can Oncol Nurs J 2018; 28:146-148. [PMID: 31148789 PMCID: PMC6516899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
The acceptance of colorectal cancer screening may be challenging for some South Asian groups in Canada. As oncology nurses, it is important to recognize barriers to screening, and be cognizant of culturally appropriate strategies to promote access in practice. This paper presents current research that was undertaken to understand population-based colorectal cancer screening among South Asian immigrants, and uses an access framework to outline strategies that minimize access barriers. Cultural safety principles and cultural assessment tools to support practice are also discussed.
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Affiliation(s)
- Joanne Crawford
- Assistant Professor, Faculty of Applied Health Sciences, Department of Nursing, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1, T: 905-688-5550, ext. 4363, ,
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Crawford J. [Not Available]. Can Oncol Nurs J 2018; 28:149-152. [PMID: 31148837 PMCID: PMC6516910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Au Canada, le dépistage du cancer colorectal peut rebuter certaines populations sud-asiatiques. En tant qu’infirmières en oncologie, il importe que nous connaissions les obstacles au dépistage de même que des stratégies culturellement appropriées pouvant être adoptées pour les surmonter. Dans cet article, nous présentons la recherche effectuée sur le dépistage du cancer colorectal chez les immigrants sud-asiatiques et utilisons un cadre sur l’accès pour dégager des stratégies permettant de lever les barrières. Nous abordons également des principes de sécurisation culturelle et examinons quelques outils d’évaluation culturelle qui peuvent être mis à profit dans la pratique infirmière.
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Affiliation(s)
- Joanne Crawford
- Professeure adjointe, Faculté des sciences appliquées de la santé, département des sciences infirmières, Université Brock, 1812, chemin Sir Isaac Brock, St. Catharines, Ontario L2S 3A1, Téléphone : 905-688-5550, poste 4363; Télécopieur : 905-688-6658, Courriel :
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Jain E, Jain BK, Kuyyadiyil S. Role of Geographic Information System Technology in Community Pediatric Screening. CURRENT OPHTHALMOLOGY REPORTS 2017. [DOI: 10.1007/s40135-017-0154-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Huang JL, Fang Y, Liang M, Li STS, Ng SKC, Hui ZSN, Ching J, Wang HH, Wong MCS. Approaching the Hard-to-Reach in Organized Colorectal Cancer Screening: an Overview of Individual, Provider and System Level Coping Strategies. AIMS Public Health 2017; 4:289-300. [PMID: 29546218 PMCID: PMC5690455 DOI: 10.3934/publichealth.2017.3.289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/19/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite the proven effectiveness of colorectal cancer (CRC) screening on reduction of CRC mortality, the uptake of CRC screening remains low. Participation rate is one of determinants for the success of organized population-based screening program. This review aims to identify those who are hard-to-reach, and summarize the strategies to increase their screening rate from individual, provider and system levels. METHODS A systematic search of electronic English databases was conducted on the factors and strategies of uptake in CRC screening for the hard-to-reach population up to May 2017. DISCUSSION The coverage rate and participation rate are two indexes to identify the hard-to-reach population in organized CRC screening program. However, the homeless, new immigrants, people with severe mental illness, the jail intimates, and people with characteristics including lower education levels and/or low socioeconomic status, living in rural/remote areas, without insurance, and racial minorities are usually recognized as hard-to-reach populations. For them, organized screening programs offer a better coverage, while novel invitation approaches for eligible individuals and multiple strategies from primary care physicians are still needed to enhance screening rates among subjects who are hard-to-reach. Suggestions implied the effectiveness of interventions at the system level, including linkages to general practice; use of decision making tools; enlisting supports from coalition; and the continuum from screening to diagnosis and treatment. CONCLUSION Organized CRC screening offers a system access to approach the hard-to-reach populations. To increase their uptake, multiple and novel strategies from individual, provider and system levels should be applied. For policymakers, public healthcare providers and community stakeholders, it is a test to tailor their potential needs and increase their participation rates through continuous efforts to eliminate disparities and inequity in CRC screening service.
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Affiliation(s)
- Jason Liwen Huang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuan Fang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Miaoyin Liang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shannon TS Li
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Simpson KC Ng
- JC bowel cancer education center, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zero SN Hui
- JC bowel cancer education center, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jessica Ching
- JC bowel cancer education center, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Harry Haoxiang Wang
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Martin Chi Sang Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong
- State Key Laboratory of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong
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Lofters AK, Vahabi M, Prakash V, Banerjee L, Bansal P, Goel S, Dunn S. Lay health educators within primary care practices to improve cancer screening uptake for South Asian patients: challenges in quality improvement. Patient Prefer Adherence 2017; 11:495-503. [PMID: 28331296 PMCID: PMC5352230 DOI: 10.2147/ppa.s127147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cancer screening uptake is known to be low among South Asian residents of Ontario. The objective of this pilot study was to determine if lay health educators embedded within the practices of primary care providers could improve willingness to screen and cancer screening uptake for South Asian patients taking a quality improvement approach. MATERIALS AND METHODS Participating physicians selected quality improvement initiatives to use within their offices that they felt could increase willingness to screen and cancer screening uptake. They implemented initiatives, adapting as necessary, for six months. RESULTS Four primary care physicians participated in the study. All approximated that at least 60% of their patients were of South Asian ethnicity. All physicians chose to work with a preexisting lay health educator program geared toward South Asians. Health ambassadors spoke to patients in the office and telephoned patients. For all physicians, ~60% of South Asian patients who were overdue for cancer screening and who spoke directly to health ambassadors stated they were willing to be screened. One physician was able to track actual screening among contacted patients and found that screening uptake was relatively high: from 29.2% (colorectal cancer) to 44.6% (breast cancer) of patients came in for screening within six months of the first phone calls. Although physicians viewed the health ambassadors positively, they found the study to be time intensive and resource intensive, especially as this work was additional to usual clinical duties. DISCUSSION Using South Asian lay health educators embedded within primary care practices to telephone patients in their own languages showed promise in this study to increase awareness about willingness to screen and cancer screening uptake, but it was also time intensive and resource intensive with numerous challenges. Future quality improvement efforts should further develop the phone call invitation process, as well as explore how to provide infrastructure for lay health educator training and time.
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Affiliation(s)
- AK Lofters
- Department of Family and Community Medicine
- Dalla Lana School of Public Health, University of Toronto
- Department of Family and Community Medicine
- Centre for Urban Health Solutions, St Michael’s Hospital
| | - M Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto
| | - V Prakash
- Screening Saves Lives Program, Canadian Cancer Society, Mississauga
| | - L Banerjee
- Wise Elephant Family Health Team, Brampton
| | - P Bansal
- Mississauga Halton Central West Regional Cancer Program, Mississauga
| | - S Goel
- Wise Elephant Family Health Team, Brampton
- Mississauga Halton Central West Regional Cancer Program, Mississauga
| | - S Dunn
- Department of Family and Community Medicine
- Dalla Lana School of Public Health, University of Toronto
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
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Bermedo-Carrasco S, Waldner C, Peña-Sánchez JN, Szafron M. Spatial variations in cervical cancer prevention in Colombia: Geographical differences and associated socio-demographic factors. Spat Spatiotemporal Epidemiol 2016; 19:78-90. [PMID: 27839583 DOI: 10.1016/j.sste.2016.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/08/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
Abstract
We examined spatial variations in the frequencies of women who had not heard of human papillomavirus vaccination (NHrd-Vac) and who had not had Pap testing (NHd-Pap) among Colombian administrative divisions (departments), before and after considering differences in socio-demographic factors. Following global and local tests for clustering, Bayesian Poisson hierarchical models identified department factors associated with NHrd-Vac and NHd-Pap, as well as the extent of the spatially structured and unstructured heterogeneity. Models of spatial variations for both outcomes included the department percentage of women with subsidised health insurance. The relative risks of NHrd-Vac and NHd-Pap were highest in several departments adjacent to the Colombian border. Our finding that the risk of not having adequate access to cervical cancer (CC) prevention programmes in Colombia was location-dependent, could be used to focus resources for CC prevention programmes.
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Affiliation(s)
- Silvia Bermedo-Carrasco
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon SK S7N 5E5, Canada.
| | - Cheryl Waldner
- Western College of Veterinary Medicine and School of Public Health, University of Saskatchewan, 52 Campus Drive Saskatoon SK S7N 5B4, Canada.
| | | | - Michael Szafron
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon SK S7N 5E5, Canada.
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Fernandes KA, Sutradhar R, Borkhoff CM, Baxter N, Lofters A, Rabeneck L, Tinmouth J, Paszat L. Small-area variation in screening for cancer, glucose and cholesterol in Ontario: a cross-sectional study. CMAJ Open 2015; 3:E373-81. [PMID: 26835437 PMCID: PMC4705009 DOI: 10.9778/cmajo.20140069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Screening for cervical, breast and colon cancers, and elevations of cholesterol and glucose, reduces premature cause-specific mortality from these cancers and circulatory diseases. Despite primary care reforms and incentives, and promotion of cancer-screening programs among individuals, participation is suboptimal. We aimed to examine participation as of Dec. 31, 2011, by factors of deprivation, demographics and primary care at the small-area level. METHODS From health care administrative databases, we identified people eligible for each screening test, and their participation, in each dissemination area (referred to as small areas, n = 18 950) in Ontario. We calculated rates for each test among small areas (overall and stratified by demographic, socioeconomic and primary care descriptors) and stratified by sex for all tests combined. We loaded all data into a geographic information system. Funnel plots were generated showing the percentage of eligible people who completed screening for all tests by small area, stratified by sex. Overall and stratified screening prevalence ratios were calculated among small areas. RESULTS Among small areas, the mean and SD for participation in all tests combined was 31.6% (SD 11.0%) for women and 41.2% (SD 12.0%) for men. Screening prevalence among small areas, for each test and for all tests combined, overall and stratified by sex, declined with decreasing percentage with high school completion, decreasing socioeconomic quintile, and decreasing percentage with an identifiable primary care physician. INTERPRETATION Our results show that the rate of participation in all eligible screening tests among small areas is much lower than the rate of participation in any one particular test. This finding has implications for the design and implementation of strategies to improve rates of screening.
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Affiliation(s)
- Kimberly A Fernandes
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Cornelia M Borkhoff
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Nancy Baxter
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Aisha Lofters
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Linda Rabeneck
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Jill Tinmouth
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Lawrence Paszat
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
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Vahabi M, Lofters A, Kumar M, Glazier RH. Breast cancer screening disparities among urban immigrants: a population-based study in Ontario, Canada. BMC Public Health 2015; 15:679. [PMID: 26194189 PMCID: PMC4508905 DOI: 10.1186/s12889-015-2050-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 07/10/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Breast cancer is one of the leading cause of mortality and morbidity in Canada. Screening is the most promising approach in identification and treatment of the disease at early stage of its development. Research shows higher rate of breast cancer mortality among ethno-racial immigrant women despite their lower incidence which suggests disparities in mammography screening. This study aimed to compare the prevalence of appropriate mammography screening among immigrant and native borne women and determine predicators of low mammography screening. METHODS We conducted secondary data analyses on Ontario linked social and health databases to determine the proportion of women who were screened during the two-year period of 2010-2012 among 1.4 million screening-eligible women living in urban centres in Ontario. We used multivariate Poisson regression to adjust for various socio-demographic, health care-related and migration related variables. RESULTS 64% of eligible women were appropriately screened. Screening rates were lowest among new and recent immigrants compared to referent group (Canadian-born women and immigrant who arrived before 1985) (Adjusted Rate Ratio (ARR) (0.87, 95% CI 0.85-0.88 for new immigrants and 0.90, 95% CI 0.89-0.91 for recent immigrants. Factors that were associated with lower rates of screening included living in low-income neighborhoods, having a male physician, having internationally-trained physician and not being enrolled in primary care patient enrolment models. Those not enrolled were 22% less likely to be screened compared to those who were (ARR 0.78, 95% CI 0.77-0.79). CONCLUSION To enhance immigrant women screening rates efforts should made to increase their access to primary care patient enrolment models and preferably female health professionals. Support should be provided to interventions that address screening barriers like language, acculturation limitations and knowledge deficit. Health professionals need to be educated and take an active role in offering screening guidelines during health encounters.
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Affiliation(s)
- Mandana Vahabi
- Faculty of Community Services, Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
- Immigration and Settlement Studies, Ryerson University, Toronto, Canada.
- Ryerson Centre for Global Health and Health Equity, Toronto, Canada.
| | - Aisha Lofters
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
- Department of Family and Community Medicine, St. Michael Hospital, Toronto, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
| | - Matthew Kumar
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
| | - Richard H Glazier
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
- Department of Family and Community Medicine, St. Michael Hospital, Toronto, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
- Dalla, Lana School of Public Health, University of Toronto, Toronto, Canada.
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Ginsburg OM, Fischer HD, Shah BR, Lipscombe L, Fu L, Anderson GM, Rochon PA. A population-based study of ethnicity and breast cancer stage at diagnosis in Ontario. ACTA ACUST UNITED AC 2015; 22:97-104. [PMID: 25908908 DOI: 10.3747/co.22.2359] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Breast cancer stage at diagnosis is an important predictor of survival. Our goal was to compare breast cancer stage at diagnosis (by American Joint Committee on Cancer criteria) in Chinese and South Asian women with stage at diagnosis in the remaining general population in Ontario. METHODS We used the Ontario population-based cancer registry to identify all women diagnosed with breast cancer during 2005-2010, and we applied a validated surname algorithm to identify South Asian and Chinese women. We used logistic regression to compare, for Chinese or South Asian women and for the remaining general population, the frequency of diagnoses at stage ii compared with stage i and stages ii-iv compared with stage i. RESULTS The registry search identified 1304 Chinese women, 705 South Asian women, and 39,287 women in the remaining general population. The Chinese and South Asian populations were younger than the remaining population (mean: 54, 57, and 61 years respectively). Adjusted for age, South Asian women were more often diagnosed with breast cancer at stage ii than at stage i [odds ratio (or): 1.28; 95% confidence interval (ci): 1.08 to 1.51] or at stages ii-iv than at stage i (or: 1.27; 95% ci: 1.08 to 1.48); Chinese women were less likely to be diagnosed at stage ii than at stage i (or: 0.82; 95% ci: 0.72 to 0.92) or at stages ii-iv than at stage i (or: 0.73; 95% ci: 0.65 to 0.82). CONCLUSIONS Breast cancers were diagnosed at a later stage in South Asian women and at an earlier stage in Chinese women than in the remaining population. A more detailed analysis of ethnocultural factors influencing breast screening uptake, retention, and care-seeking behavior might be needed to help inform and evaluate tailored health promotion activities.
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Affiliation(s)
- O M Ginsburg
- Women's College Research Institute, Women's College Hospital, Toronto, ON. ; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON. ; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON
| | - H D Fischer
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - B R Shah
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON. ; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON. ; Institute for Clinical Evaluative Sciences, Toronto, ON
| | - L Lipscombe
- Women's College Research Institute, Women's College Hospital, Toronto, ON. ; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON. ; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON. ; Institute for Clinical Evaluative Sciences, Toronto, ON
| | - L Fu
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - G M Anderson
- Women's College Research Institute, Women's College Hospital, Toronto, ON. ; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON. ; Institute for Clinical Evaluative Sciences, Toronto, ON
| | - P A Rochon
- Women's College Research Institute, Women's College Hospital, Toronto, ON. ; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON. ; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON. ; Institute for Clinical Evaluative Sciences, Toronto, ON
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Lofters AK, Ng R, Lobb R. Primary care physician characteristics associated with cancer screening: a retrospective cohort study in Ontario, Canada. Cancer Med 2014; 4:212-23. [PMID: 25430885 PMCID: PMC4329005 DOI: 10.1002/cam4.358] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/05/2014] [Accepted: 08/12/2014] [Indexed: 12/25/2022] Open
Abstract
Primary care physicians can serve as both facilitators and barriers to cancer screening, particularly for under-screened groups such as immigrant patients. The objective of this study was to inform physician-targeted interventions by identifying primary care physician characteristics associated with cancer screening for their eligible patients, for their eligible immigrant patients, and for foreign-trained physicians, for their eligible immigrant patients from the same world region. A population-based retrospective cohort study was performed, looking back 3 years from 31 December 2010. The study was performed in urban primary care practices in Ontario, Canada's largest province. A total of 6303 physicians serving 1,156,627 women eligible for breast cancer screening, 2,730,380 women eligible for cervical screening, and 2,260,569 patients eligible for colorectal screening participated. Appropriate breast screening was defined as at least one mammogram in the previous 2 years, appropriate cervical screening was defined as at least one Pap test in the previous 3 years, and appropriate colorectal screening as at least one fecal occult blood test in the previous 2 years or at least one colonoscopy or barium enema in the previous 10 years. Just fewer than 40% of physicians were female, and 26.1% were foreign trained. In multivariable analyses, physicians who attended medical schools in the Caribbean/Latin America, the Middle East/North Africa, South Asia, and Western Europe were less likely to screen their patients than Canadian graduates. South Asian-trained physicians were significantly less likely to screen South Asian women for cervical cancer than other foreign-trained physicians who were seeing region-congruent patients (adjusted odds ratio: 0.56 [95% confidence interval 0.32–0.98] versus physicians from the USA, Australia and New Zealand). South Asian patients were the most vulnerable to under-screening, and decreasing patient income quintile was consistently associated with lower likelihood of screening, although less so for immigrant patients. This study highlights certain physician characteristics that are associated with cancer screening for eligible patients, including immigrant patients, and that should be considered when designing physician-targeted interventions. We have also highlighted an ethnic community, South Asians, which requires particular attention, both among its patients and its primary care providers. Future research should further explore the reasons for these findings.
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Affiliation(s)
- Aisha K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
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Gesink D, Mihic A, Antal J, Filsinger B, Racey CS, Perez DF, Norwood T, Ahmad F, Kreiger N, Ritvo P. Who are the under- and never-screened for cancer in Ontario: a qualitative investigation. BMC Public Health 2014; 14:495. [PMID: 24885998 PMCID: PMC4229738 DOI: 10.1186/1471-2458-14-495] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/14/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Observed breast, cervical and colon cancer screening rates are below provincial targets for the province of Ontario, Canada. The populations who are under- or never-screened for these cancers have not been described at the Ontario provincial level. Our objective was to use qualitative methods of inquiry to explore who are the never- or under-screened populations of Ontario. METHODS Qualitative data were collected from two rounds of focus group discussions conducted in four communities selected using maps of screening rates by dissemination area. The communities selected were archetypical of the Ontario context: urban, suburban, small city and rural. The first phase of focus groups was with health service providers. The second phase of focus groups was with community members from the under- and never-screened population. Guided by a grounded theory methodology, data were collected and analyzed simultaneously to enable the core and related concepts about the under- and never-screened to emerge. RESULTS The core concept that emerged from the data is that the under- and never-screened populations of Ontario are characterized by diversity. Group level characteristics of the under- and never-screened included: 1) the uninsured (e.g., Old Order Mennonites and illegal immigrants); 2) sexual abuse survivors; 3) people in crisis; 4) immigrants; 5) men; and 6) individuals accessing traditional, alternative and complementary medicine for health and wellness. Under- and never-screened could have one or multiple group characteristics. CONCLUSION The under- and never-screened in Ontario comprise a diversity of groups. Heterogeneity within and intersectionality among under- and never-screened groups adds complexity to cancer screening participation and program planning.
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Affiliation(s)
- Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada.
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Lobb R, Carothers BJ, Lofters AK. Using organizational network analysis to plan cancer screening programs for vulnerable populations. Am J Public Health 2014; 104:358-64. [PMID: 24328613 PMCID: PMC3935666 DOI: 10.2105/ajph.2013.301532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined relationships among organizations in a cancer screening network to inform the development of interventions to improve cancer screening for South Asians living in the Peel region of Ontario. METHODS From April to July 2012, we surveyed decision-makers, program managers, and program staff in 22 organizations in the South Asian cancer screening network in the Peel region. We used a network analytic approach to evaluate density (range = 0%-100%, number of ties among organizations in the network expressed as a percentage of all possible ties), centralization (range = 0-1, the extent of variability in centrality), and node characteristics for the communication, collaboration, and referral networks. RESULTS Density was similar across communication (15%), collaboration (17%), and referral (19%) networks. Centralization was greater in the collaboration network (0.30) than the communication network (0.24), and degree centralization was greater in the inbound (0.42) than the outbound (0.37) referral network. Diverse organizations were central to the networks. CONCLUSIONS Certain organizations were unexpectedly important to the South Asian cancer screening network. Program planning was informed by identifying opportunities to strengthen linkages between key organizations and to leverage existing ties.
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Affiliation(s)
- Rebecca Lobb
- Rebecca Lobb is with the Department of Surgery, Division of Public Health Sciences, School of Medicine, and Bobbi J. Carothers is with the George Warren Brown School of Social Work, Center for Public Health Systems Science, Washington University, St Louis, MO. Rebecca Lobb is also with the Keenan Research Centre, Li Ka Shing Knowledge Institute, and Aisha K. Lofters is with the Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON
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Carrière GM, Sanmartin C, Bryant H, Lockwood G. Rates of cancer incidence across terciles of the foreign-born population in Canada from 2001-2006. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2013; 104:e443-9. [PMID: 24495818 PMCID: PMC6973830 DOI: 10.17269/cjph.104.3884] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 10/25/2013] [Accepted: 10/29/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To address the issue of comparative risk of cancer in Canada's immigrant population, an area-based methodology was applied to examine whether or not estimated cancer incidence rates among individuals living in given areas vary systematically according to the concentration of foreign-born individuals living in the same area. This method provides an alternative, accessible surveillance method in the absence of linked individual-level information to extend the work of others by providing both national and subnational standardized, hence comparable, results to address this issue. METHODS Canadian Cancer Registry data (2001 to 2006) and 2006 Census data provided dissemination area information regarding the concentration of the foreign-born population and population estimates for rate denominators. Cancer (all cause and cause-specific) incidence rate ratios (age-standardized and by age/sex) were calculated by foreign-born concentration areas at both national and regional levels. RESULTS An inverse gradient was identified between cancer incidence rates and area concentration of foreign-born, with the all-sites cancer rate ranging from a low of 388 per 100,000 among individuals living in areas with a high concentration of foreign-born to a high of 493 per 100,000 among individuals living in areas with a low concentration of foreign-born. This pattern occurred nationally for lung, colorectal, prostate and female breast cancers. However, for liver, nasopharynx, and thyroid cancers, higher cancer rates were observed in areas with a higher versus lower concentration of foreign-born populations. CONCLUSION The study findings provide suggestive evidence of decreased cancer risk among foreign-born populations for most cancers except nasopharynx, liver and thyroid for which risks were higher. The results of this study demonstrate the value of ecological-based methods for disease surveillance in the absence of individual-level information on immigrant status in the national cancer registry.
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