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Healthcare Access, SES, and Late-Stage Cancer Diagnosis: Public Policy Implications Sara McLafferty Department of Geography and GIS University of Illinois.

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Presentation on theme: "Healthcare Access, SES, and Late-Stage Cancer Diagnosis: Public Policy Implications Sara McLafferty Department of Geography and GIS University of Illinois."— Presentation transcript:

1 Healthcare Access, SES, and Late-Stage Cancer Diagnosis: Public Policy Implications Sara McLafferty Department of Geography and GIS University of Illinois at Urbana- Champaign

2 “On Airs, Waters and Places …” Hippocrates c. 400 B.C.

3 Place, space, and health Places – environments infused with meaning Places – environments infused with meaning Complex pathways link place characteristics and health Complex pathways link place characteristics and health Spatial characteristics of places are important Spatial characteristics of places are important People experience places differently People experience places differently “People create places and places create people” (MacIntyre and Ellaway 2003) “People create places and places create people” (MacIntyre and Ellaway 2003)

4 Crosscutting trends “New” public health – context, environments Risky environments (Rhodes et al. 2005)Risky environments (Rhodes et al. 2005) Social epidemiology (Diez Roux 2010)Social epidemiology (Diez Roux 2010) Built environment (Hembree et al. 2005)Built environment (Hembree et al. 2005) Data and methods for geographical analysis Huge increase in spatial and environmental data Geographic information systems (GIS) Spatial analysis methods and software Public Health Spatial Analysis How can we leverage these trends to enhance cancer control and prevention through effective place-based interventions?

5 Organization of presentation Overview of place, space and spatial analysis Overview of place, space and spatial analysis Geographic disparities in cancer Geographic disparities in cancer Geographic foundations for cancer control, prevention and intervention Geographic foundations for cancer control, prevention and intervention Spatial targetingSpatial targeting Spatial tailoringSpatial tailoring Spatial generatingSpatial generating

6 Spatial analysis methods: tools for visualizing, analyzing and modeling geospatial information about places

7 Spatial Data Information linked to a place (s, y, t) – Place/location (s) – Attribute (y) – Time (t) Spatial data have characteristic geometries

8 Spatial perspective: Distance Pattern Proximity Place Detailed characteristics of people and environment in a locality, and meanings and experiences associated with environment

9 Spatial analysis methods are used to visualize, explore and model spatial data and their interrelationships How Chicago would look if % black population had a random spatial distribution The actual spatial distribution of % black population shows strong spatial autocorrelation

10 Low birthweight infants, Brooklyn NY, 2000 Spatial perspectives help us to “see” places more effectively

11 Kernel Density Estimation s =    k d i  di<di< Where: s = est. density at grid point s d i = distance from point i to grid point s  = bandwidth k( ) = kernel function Hotspot mapping

12 Move a filter across the map

13 LBW Density, 1.0 mile bandwidth

14 LBW Density, 2.0 mile bandwidth

15 How do these concepts relate to cancer research, control, and Intervention? Cancer Disparities : “Distinguished by race/ethnicity, gender, age, socioeconomic status, geographic location, occupation, and education, underserved population groups across the United States suffer disproportionately high cancer incidence and mortality rates for a variety of reasons. These individuals are significantly more likely than the overall U.S. population to: Be diagnosed with and die from preventable cancers. Be diagnosed with late stage disease for cancers detectable at an early stage through screening …” “Overcoming Cancer Disparities,”

16 reflecting complex individual, socioeconomic, health care, and environmental factors Cancer incidence Screening Early diagnosis Treatment Care Vary from place to place

17 Geographic inequalities in cancer incidence: Predicted U.S. cervical cancer incidence (A) and mortality rates (B) by county, 1995 to Horner M et al. Cancer Epidemiol Biomarkers Prev 2011;20: ©2011 by American Association for Cancer Research

18 Geographic inequalities in cancer incidence: Age-adjusted incidence rate of all childhood (ages 0-19) cancers in males by Health Service Area, Zhu, L., Pickle, LW, Zou, Z, Cucinelli, J. (2014) Trends and patterns of childhood cancer incidence in the United States, Statistics and its Interface, 7,

19 Spatial filtering reveals geographic variation in colorectal cancer incidence in Iowa Beyer, K., Tiwari, C., Rushton G. (2012) Five essential properties of disease maps, Annals of the AAG, 102,

20 Cancer screening varies from place to place

21 Percent of women ages 18 years and more who reported having had a Papanicolaou smear test within the past 3 years by county—continental United States, 2000 to Horner M et al. Cancer Epidemiol Biomarkers Prev 2011;20: ©2011 by American Association for Cancer Research

22 Strong geographic disparities exist in cancer stage at diagnosis

23 Late-Stage Breast Cancer Diagnosis varies across Illinois

24 Mammography facilities are not available in many places of high late-stage risk

25 Rural-Urban Gradient in Late-stage Cancer McLafferty S., Wang F. (2009). Rural Reversal? Risk of late-stage cancer across the rural-urban continuum in Illinois. Cancer,

26 Access to health care resources for cancer screening and treatment is geographically and socially uneven

27 Uneven Access to Oncologists

28 And Primary Care Physicians

29 Onega T. et. al. (2010) Influence of place of residence in access to specialized cancer care for African-Americans. Journal of Rural Health, 26, And access to cancer treatment resources differs socially and spatially: Vulnerable populations often have limited access to, and are less likely to utilize, the most effective cancer treatments

30 Our research in Illinois shows that places are associated with late-stage cancer via: Socioeconomic disparities Socioeconomic disparities Low incomesLow incomes Vulnerable, high-need populationsVulnerable, high-need populations Access to primary care services Access to primary care services Only outside ChicagoOnly outside Chicago Transportation barriersTransportation barriers

31 How can we leverage our ability to map, analyze, and understand the relationships between place, space, and cancer to inform treatment and control policies and interventions?

32 Geospatial contributions Spatial (place) targeting Spatial (place) targeting Spatial (place) tailoring Spatial (place) tailoring Spatially generating Spatially generating

33 Spatial Targeting Focus resources and interventions to high- prevalence, high-risk places Focus resources and interventions to high- prevalence, high-risk places Methods Methods Hotspot mappingHotspot mapping Heat mappingHeat mapping Spatial cluster detectionSpatial cluster detection Risk mappingRisk mapping Hotspot

34 Spatial Targeting Rooted in infectious disease control and eradication activities Smallpox eradication (Henderson 1980) – Disease surveillance – “highly targeted, intensive containment vaccination (p. 426)”

35 Carter R., Mendis K, Roberts R. (2000) Spatial targeting of interventions against Malaria. Bull World Health Assoc, 78, Rationale for spatial targeting: Geographically bounded processes

36 Spatial targeting for other types of health issues Petersen J. et al. (2009) Teenage pregnancy: New tools to support local health campaigns. Health & Place, 15, Rationale is primarily economic

37 Need to think more critically about spatial targeting Need to think more critically about spatial targeting Where to target? Where are the hotspots?Where to target? Where are the hotspots? Hotspots are heterogeneousHotspots are heterogeneous Hotspots in cold spotsHotspots in cold spots Hidden populationsHidden populations StigmatizationStigmatization

38 Where is the Hotspot? Clusters of high LBW among infants born to immigrant mothers in Brooklyn & Queens, 2000 SaTScan

39 Hotspots are Heterogeneous

40 Hotspots differ in Immigrant population composition, housing characteristics, population density, access to public transportation

41 Hot spots within cold spots % Late-stage breast cancer diagnosis Other32.1% African-American45.6% In small metropolitan areas in Illinois, the risk of late breast cancer diagnosis is low for most women, but very high for African-American women

42 Hotspots reflect the interlocking effects of people and places

43 Spatial tailoring Place-specific customizing of interventions Place-specific customizing of interventions Detailed knowledge of local environment, people’s livelihoods and economic well-being, sociocultural characteristics, spatial interactions, processes that put people at risk Detailed knowledge of local environment, people’s livelihoods and economic well-being, sociocultural characteristics, spatial interactions, processes that put people at risk Place characteristics (people & environment) affect design and implementation Place characteristics (people & environment) affect design and implementation Smallpox eradication, AfghanistanSmallpox eradication, Afghanistan Not-on-Tobacco, West Virginia (Rothermel et al. 2011)Not-on-Tobacco, West Virginia (Rothermel et al. 2011) Kreuter MW, Skinner CS (2000) Tailoring: What’s in a name? Health Educ Res, 15(1), 1-4

44 Community mapping to support Healthy Start (Aronson et al. 2007) Examples of place characteristics important for maternal & infant health: Houses of worship Businesses Liquor licenses Vacant houses Aronson RE, Wallis AB, O’Campo PJ, Schafer P (2007). Neighborhood mapping and evaluation: A methodology for participatory community health initiatives. Matern Child Health J, 11,

45 Spatially Generating Community input in design of interventions Community input in design of interventions Bottom-up participatory processesBottom-up participatory processes Local knowledgeLocal knowledge Participatory GIS (PGIS) Participatory GIS (PGIS)

46 Beyer KMM, Comstock S, Seagren R. (2010) Disease maps as context for community mapping. J Community Health, 33, Colorectal cancer intervention in Storm Lake, IA

47 Summary Place matters! Place matters! Cancer inequalities patterned over space Cancer inequalities patterned over space Diverse populations have diverse geographies and diverse experiences of place Diverse populations have diverse geographies and diverse experiences of place Geography affects social interactions, environmental exposures and access to resources and services Geography affects social interactions, environmental exposures and access to resources and services We can leverage these understandings to improve cancer control and prevention through the thoughtful application of strategies of spatial/place targeting, tailoring and generating We can leverage these understandings to improve cancer control and prevention through the thoughtful application of strategies of spatial/place targeting, tailoring and generating

48 THANK YOU!


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