Running Head: DATA ANALYSIS PLAN 1

Association between health insurance and breast cancer for low income Hispanic society

Name

Institution

Professor

Course

Date
 DATA ANALYSIS PLAN 2

Abstract

Timely recognition and follow-up of unusual cell changes can help in early finding of

bosom growth, in this way prompting better treatment results. Be that as it may, in spite of

significant bosom growth screening activities, the extent of female bosom malignancy cases

analyzed at late stages stays high. Separation to screening centers may influence access to mind,

especially for ladies living in devastated regions with restricted method for dependable

transportation. Using bosom tumor screening information gathered by the Illinois Breast and

Cervical Cancer Program somewhere around 1996 and 2010, we analyzed the impact of travel

separation to the center from which ladies got bosom disease screening tests in front of an audience

of analysis.

Discoveries demonstrated that individual and neighborhood sociodemographic attributes

are specifically and in a roundabout way connected with anomalous mammogram comes about,

and that separation to a center may intervene, to some degree, the impacts of individual qualities

and neighborhood weakness on the likelihood of having an unusual mammogram.

Data dictionary

Breast Cancer Disparities

Bosom disease is the second-driving reason for tumor related demise in ladies (Edwards et

al., 2010; National Cancer Institute, 2011). Despite the fact that amid the 2000s the bosom disease

demise rate has dropped consistently, in 2011, an expected 230,480 new instances of obtrusive

bosom growth were relied upon to be analyzed in ladies in the U.S., alongside 57,650 new

instances of non-intrusive (in situ) bosom malignancy (Breastcancer.org, 2011).

The rate of bosom growth has been reliably higher for white ladies, and in 2008, the

occurrence was 130 for each 100,000 white ladies, contrasted and 126 for every 100,000 dark
 DATA ANALYSIS PLAN 3

ladies (National Cancer Institute, 2010b). Be that as it may, survival rates are lower among dark

ladies. Somewhere around 2003 and 2007, the bosom tumor death rate was 155/100,000 for white

ladies and 181/100,000 for dark ladies. Essentially, five-year survival was likewise higher among

white ladies contrasted and dark ladies (91% versus 78%, individually) (National Cancer Institute,

2010b). This example holds for the condition of Illinois, where the death rate was 30 for each

100,000 for white ladies and 39 for every 100,000 for dark ladies (Illinois Department of Public

Health, 2009).

In spite of the accessibility of generally basic and cheap screening instruments,

racial/ethnic minority ladies of low financial status (SES) are all the more regularly analyzed at a

later phase of bosom malignancy and, thusly, the death rates are higher for racial/ethnic minority

ladies contrasted and the rates among white ladies (Cross, Harris, and Recht, 2002; Eley et al.,

1994; Grisby, Hall-Daniels, Baker, and Perez, 2000; Mandelblatt, Andrews, J., Zauber, and

Burnett, 1991; Mundt, Connell, and Campbell, 1998; Roetzheim et al., 1999; Wang, McLafferty,

Escamilla, and Luo, 2008).

Methods

Variable names

We used the bosom disease screening information gathered by the Illinois Breast and

Cervical Cancer Program (IBCCP), between November 20, 1996 and May 10, 2010. The IBCCP

expects to give bosom and cervical malignancy screening and symptomatic tests to low-pay,

uninsured, and underinsured ladies. IBCCP administrations are accessible to ladies living

underneath 250% of government neediness level. Of those, we limited our investigation to the 98%

of people (n=32,175) who lived in Cook County, IL.

DATA ANALYSIS PLAN 4

TABLE 1—

Rates of Selected Characteristics of Women Aged 40 to 64, by Race/Ethnicity: United

States, 1998

Non-Hispanic White (n Non-Hispanic Black (n Hispanic (n =

= 3995), % (SE) = 780), % (SE) 734), % (SE)
Recent mammogram 70.3 (0.8) 66.7 (2.1) 59.5 (2.1)
Recent test 83.4 (0.7) 85.0 (1.6) 79.6 (1.6)
Has a usual source of care
No 6.8 (0.4) 8.5 (1.3) 12.4 (1.3)
Yes 93.2 (0.4) 91.5 (1.3) 87.6 (1.3)
Income
Below 200% of 15.8 (0.6) 43.5 (2.1) 50.9 (2.4)
federal poverty level
Above 200% of 84.2 (0.6) 56.5 (2.1) 49.1 (2.4)
federal poverty level
Education
Less than high 9.7 (0.6) 23.3 (1.8) 45.0 (2.2)
school
High school or 32.5 (0.8) 31.4 (1.9) 22.1 (1.8)
equivalent
Some college or 31.8 (0.8) 29.5 (1.9) 21.9 (1.9)
associate’s degree
Bachelor’s degree 26.1 (0.8) 15.8 (1.5) 11.0 (1.4)
or higher
Health insurance
No health 9.1 (0.5) 19.2 (1.7) 31.5 (2.2)
insurance coverage
Medicaid 3.4 (0.3) 13.0 (1.3) 13.3 (1.3)
Private health 87.5 (0.6) 67.8 (1.9) 55.1 (2.3)
insurance
Marital status
Not married 27.2 (0.7) 60.0 (2.2) 36.4 (2.0)
Married 72.8 (0.7) 40.0 (2.2) 63.6 (2.0)
Self-reported health status
Fair or poor 9.9 (0.5) 23.2 (1.7) 23.2 (1.9)
Excellent, very 90.1 (0.5) 76.8 (1.7) 76.8 (1.9)
good, or good
Cigarette smoker
Former/never 75.9 (0.8) 71.3 (1.8) 85.6 (1.4)
 DATA ANALYSIS PLAN 5

Non-Hispanic White (n Non-Hispanic Black (n Hispanic (n =

= 3995), % (SE) = 780), % (SE) 734), % (SE)
Current 24.1 (0.8) 28.7 (1.8) 14.4 (1.4)
MSA residence
No 24.8 (1.0) 14.8 (2.0) 9.6 (1.7)
Yes 75.2 (1.0) 85.2 (2.0) 90.4 (1.7)

 Note. Due to rounding, percentages may not sum to 100%. MSA = metropolitan
statistical area.

Individual private locations were geocoded utilizing ArcGIS 10. The 10.0 North America

Geocode Service was utilized as the Address Locator. Evaluation tract-level socio-demographic

information from the US Census Bureau were added to the dataset. Statistics information from

2000 were utilized to coordinate as a midpoint for the era the IBCCP information were gathered

(1996–2010). Utilizing the Hawth's Analysis Tools expansion (ArcGIS 9), we computed the

separation in miles between the private areas to the IBCCP center where ladies got mammograms.

An aggregate of 17 IBCCP offices gave care. Of those, five offices were avoided from the

investigation. Since these offices had more than one facility site, we were not ready to ascertain

the real separation to the center where ladies acquired a mammogram. Mammogram comes about

because of the 12 remaining offices included 21,085 one of a kind people. Street numbers were

utilized to compute separation to center. Also, individual sociodemographic data and registration

tract-level financial variables were incorporated into this study.

TABLE 2—

Adjusted Odds Ratios (ORs) of Having a Recent Mammogram, Women Aged 40 to 64, by
Race/Ethnicity: United States, 1998

Non-Hispanic White Non-Hispanic Black Hispanic OR

OR (95% CI) OR (95% CI) (95% CI)
Has a usual source of care
DATA ANALYSIS PLAN 6

Non-Hispanic White Non-Hispanic Black Hispanic OR

OR (95% CI) OR (95% CI) (95% CI)
No 1.00 1.00 1.00
Yes 3.84 (2.86, 5.16)* 6.24 (3.01, 12.92)* 3.59 (2.00,
6.46)*
Income
Below 200% of federal 1.00 1.00 1.00
poverty level
Above or at 200% of 1.56 (1.21, 2.01)* 2.93 (1.83, 4.71)* 1.53 (0.94, 2.50)
federal poverty level
Education
Less than high school 1.00 1.00 1.00
High school or equivalent 1.27 (0.96, 1.67) 0.93 (0.52, 1.64) 1.14 (0.71, 1.84)
Some college or 1.37 (1.04, 1.81)* 0.85 (0.47, 1.53) 1.29 (0.75, 2.22)
associate’s degree
Bachelor’s degree or 1.56 (1.16, 2.09)* 1.16 (0.55, 2.44) 0.94 (0.45, 1.97)
higher
Health insurance
No health insurance 1.00 1.00 1.00
coverage
Medicaid 2.13 (1.33, 3.41)* 2.04 (1.07, 3.89)* 1.20 (0.67, 2.13)
Private health insurance 2.56 (1.93, 3.38)* 1.69 (0.99, 2.87) 2.44 (1.43,
4.15)*
Marital status
Not married 1.00 1.00 1.00
Married 1.05 (0.88, 1.24) 0.87 (0.57, 1.31) 0.69 (0.46, 1.03)
Self-reported health status
Fair or poor 1.00 1.00 1.00
Excellent, very good, or 0.72 (0.53, 0.98)* 1.03 (0.66, 1.59) 0.85 (0.52, 1.40)
good
Cigarette smoker
Former/never 1.00 1.00 1.00
Current 0.52 (0.44, 0.62)* 0.62 (0.42, 0.91)* 0.94 (0.59, 1.49)
MSA residence
No 1.00 1.00 1.00
Yes 1.19 (0.98, 1.45) 1.31 (0.78, 2.21) 1.74 (0.92, 3.27)

 Note. ORs are adjusted for all other variables in the model. CI = confidence interval.
 *P < .05. All P values are 2-tailed.

Types of Variables

Dependent variables
 DATA ANALYSIS PLAN 7

The essential variable of enthusiasm for this examination was the separation to bosom

malignancy screening facilities. We utilized the separation as a needy variable looking at the

impact of race/ethnicity and other applicable variables. We likewise utilized the separation variable

as an autonomous variable to clarify irregular mammogram comes about, controlling for every

other variable.

The private location and the area of the IBCCP facility from which every individual got

her screening administration were geocoded. The separation went to a facility was figured by

measuring the separation in miles amongst longitude and scope of private area and the center from

which the ladies got the screening administration. Statistics tract numbers were allocated to the

cases in view of private locations.

A dichotomous variable showing mammogram comes about (typical versus anomalous

discoveries) was made. Anomalous discoveries included: Lobular in situ (LCIS), Ductal in situ

(DCIS), gentle dysplasia (CIN 1), moderate dysplasia (CIN 2), extreme dysplasia, carcinoma in

situ, or adenocarcinoma in situ (AIS) (CIN 3).

Independent variables

Individual sociodemographic variables included race/ethnicity, age, wage, conjugal status,

instruction, and work status. Race/ethnicity included four classifications (Black, Hispanic, White,

and other race/ethnic gathering). Age was ordered into four gatherings: under 40 years (overlooked

classification), 40 to 49 years, 50 to 64 years, and 65 and more established. Pay was assembled

into quartiles: under $7,200, $7,200–$12,000, $12,000–$16,320, and more than $16,320. Conjugal

status was sorted into the accompanying: never wedded, wedded, widowed, and separated/isolated.

Instruction level was dichotomized: not as much as secondary school training versus secondary
 DATA ANALYSIS PLAN 8

school graduate or more. Work status was isolated into all day business, low maintenance vocation,

or unemployed.

Enumeration tract-level demographic data included percent of inhabitants living

underneath destitution line and percent of African American occupants. We figured a component

score showing the level of hindrance utilizing: % destitution, % African Americans, % female

headed families with youngsters, % not as much as secondary school instruction, middle salary,

and % unemployed. The element investigation produced two parts. We looked at the model

utilizing the element score and the model with % neediness and % African Americans as

independent variables (comes about not appeared). We found no contrast between the two

methodologies and hence utilized the crude variables.

Statistical tests for the study outcomes

Sample characteristics

In general, more than 72% of ladies got one administration and 95% used the IBCCP

administrations three times or less (extended 1 to 11 visits). Table 1 depicts qualities of ladies in

the examination. Around 45% of ladies who got mammogram from the IBCCP were Hispanic and

around 37% were dark. Ladies who were White or different ethnicities each represented under

10% of the example. More than 60% of ladies were between 50 years and 64 years of age, and an

extra 33% were somewhere around 40 and 49 years of age. The lion's share of ladies had more

than a HS training, yet more than 56% were unemployed. The mean family salary was $12,790

(median=$12,000), and ladies in the main 25% quartile had a yearly family pay over $16,320.

Conforming for the quantity of individuals living in family, just 1.5% did not meet the IBCCP's

250% destitution line criteria. Almost 40% were hitched and 23% had never been hitched/single.
 DATA ANALYSIS PLAN 9

The mean separation from ladies' private area to the center was 5.2 miles; with the middle

of 4.4 miles. A little more than 41% voyaged more distant than the normal. The dominant part of

follow-up test outcomes were ordinary; an aggregate of 173 ladies (0.8%) were found to have

strange bosom growth screening comes about. By and large, bivariate examination comes about

demonstrated that ladies who are white, more established than 65 years old, with a secondary

school or more training, utilized low maintenance, and the widowed will probably have unusual

results.

Racial/Ethnic differences

Every illustrative variable incorporated into the study were essentially distinctive between

racial/ethnic gatherings. White ladies had the most astounding % of anomalous results, and

ventured to every part of the most distant separation to center. Hispanic ladies ventured to every

part of the most brief separation to center. By and large, dark ladies were more seasoned (54 years)

than other racial/ethnic ladies; and Hispanic ladies were more youthful (51 years) than other

racial/ethnic ladies. Just 60% of Hispanic ladies had a secondary school training; while 77% of

other racial/ethnic ladies, 75% of dark ladies, and 72% of white ladies had finished secondary

school or more instruction. The normal pay was likewise the most elevated among other

racial/ethnic ladies, trailed by white and Hispanic ladies. Dark ladies had the most minimal normal

family unit salary. More than 30% of Hispanic ladies were utilized full-time, while 18% of white

and 19% of dark ladies were utilized full-time.

Evaluation tract level neighborhood attributes were essentially distinctive by racial/ethnic

gathering. The normal percent of inhabitants living underneath the neediness line was most
DATA ANALYSIS PLAN 10

noteworthy for dark ladies (22%), trailed by Hispanic ladies (17%), other ladies (16%), and white

ladies (11%). A comparable example was appeared for % female headed family units and %

unemployed. The normal extent of inhabitants with not as much as secondary school training was

fundamentally higher for Hispanic ladies (41%), while it was 27% for dark and other racial/ethnic

ladies, and 24% for white ladies. In general, white ladies were living in transcendently white

groups (68% whites), contrasted and dark ladies (17% of occupant were whites); and dark ladies

were living in transcendently dark groups (76% dark occupants), contrasted and other racial

gatherings (somewhere around 11% and 12% of inhabitants being dark).

Distance to the clinics

At the point when just the race/ethnicity sham variables were in the model, dark ladies

voyaged a shorter separation yet Hispanic ladies made a trip a more drawn out separation to a

facility contrasted and white ladies (Model I).

In any case, controlling for applicable individual and registration tract level

sociodemographic variables (Models II and III), the distinction amongst Hispanic and white ladies

vanished; however dark ladies voyaged a shorter separation contrasted and white ladies. This

outcome upheld Hypothesis I: the normal separation to the center may vary by race/ethnicity.

Moreover, ladies more youthful than 40 years old voyaged longer separations contrasted and ladies

40–49 years of age. Ladies in the most astounding wage quartile voyaged longer separations than

ladies in the lower wage quartiles. Ladies utilized full-time traveled shorter separations contrasted

and those utilized low maintenance. Ladies living in neighborhoods with a more prominent extent

of neediness voyaged shorter separations, controlling for different variables. Be that as it may, the
DATA ANALYSIS PLAN 11

statistics tract level extent of African American inhabitants was not connected with travel

separation to centers.

Abnormal mammogram results

At the point when the separation measure was presented, the contrast amongst highly

contrasting ladies was no more measurably critical, controlling for different variables (Models II).

In any case, Hispanic and other race/ethnic ladies were more outlandish than white ladies to have

an unusual mammogram. Moreover, Model II demonstrates the noteworthy impact of separation

on irregular mammogram: for every one mile increment out there to center, the probability of

having strange mammogram comes about expanded by six percent. This outcome upheld our

Hypothesis II: separation to screening offices independently affects the probability of having an

anomalous mammogram.

Discussion

Our discoveries propose that the separation ladies set out to a facility was a critical indicator

for having an irregular mammogram, controlling for significant individual and group level

sociodemographic qualities. IBCCP gives free bosom growth screening administrations to ladies

without medical coverage, so by definition, ladies in our investigation were dominatingly minority

ladies living in destitution. For such ladies with constrained assets who don't have entry to solid

transportation, access to and nearness to medicinal services offices is a vital component that could

influence routine screening and opportune development.

Racial/ethnic contrasts were seen in the chances of having irregular results. White ladies

will probably have anomalous mammogram comes about, contrasted and dark, Hispanic, and other

ethnic ladies, yet subsequent to controlling for separation to facility, the dark white distinction was

no more noteworthy, while Hispanic and different ethnicities kept on being less inclined to have
DATA ANALYSIS PLAN 12

unusual results. Curiously, white ladies ventured to every part of the most remote contrasted with

all other racial/ethnic ladies, albeit white ladies will probably have strange results. This discovering

sets a huge arrangement suggestion regarding designating assets, for example, deciding areas of

IBCCP facilities. Plainly, IBCCP facilities are deliberately situated in poor neighborhoods.

Ladies utilized full-time were 44% more averse to have a strange mammogram, contrasted

and ladies utilized low maintenance. Besides, the normal travel separation was shorter for ladies

utilized full-time than for ladies utilized low maintenance. This finding may mirror the way that

Hispanic ladies have moderately bring down rates of strange mammograms, shorter normal travel

separations to facilities, and will probably be utilized full-time (31%) contrasted and whatever

other ladies (18%–24%). Notwithstanding, it is not clear whether the relationship between job

status and access to mind among the poor underserved ladies may mean some other dormant

attributes of the people and the areas, (for example, aggregate adequacy and social capital)

reinforces the limit for people and neighborhoods to promoter themselves and to get fundamental

assets, for example, IBCCP centers or other group wellbeing facilities. Further research is justified

to explore the impact of vocation on aggregate viability and access to mind.

Generally speaking, the discoveries proposed that how far ladies live from bosom

malignancy screening offices was connected with a more noteworthy probability of having

irregular mammogram comes about. Also, race/ethnicity, age, instruction, salary, conjugal status,

livelihood status, and neighborhood neediness and racial structure were connected with separation

to screening offices. These discoveries affirm our reasonable model with which we guessed that

more extensive social variables impact wellbeing results, for this situation, anomalous

mammogram comes about. While separation to screening offices was a critical variable

influencing the probability of having an unusual mammogram among impeded ladies, such access
DATA ANALYSIS PLAN 13

to mind and the closeness to care was a component of other individual and neighborhood level

sociodemographic elements.

Conclusion

Our study demonstrated that separation to malignancy screening centers is connected with

the probability of having an irregular mammogram. Access to quality consideration helps ladies

get standard screening and auspicious follow-up of strange changes, which thus brings about prior

finding of bosom malignancy. Having tumor screening offices up close and personal might be

much more vital to burdened ladies who might not have entry to solid transportation. There is a

requirement for creating compelling wellbeing approach and arranging that can defeat obstructions

to access to vital routine growth screening. As of late, Chicago and Cook County, IL where this

investigation was based, has encountered huge sociodemographic changes. The gentrification

procedure may have added to lessening moved destitution in specific ranges, which could have

positively affected the wellbeing of inhabitants living in such zones. In any case, such changes in

the region activated sociodemographic changes, and as a result, inward city poor minorities may

have been migrated/scattered to rural ranges. This presents potential difficulties as people with

restricted assets may have ended up scattered to more extensive rural zones, which would require

another method for planning human services and other social administrations for the underserved.

Other major social components may decide, in any event to some extent, the level of access

to mind in any case. Future research needs to investigate other intervening elements,

notwithstanding the separation to the center, which may influence growth results. Neighborhood

social attributes, for example, aggregate viability, social capital, and informal organization, are

less inquired about elements that may influence human services use and wellbeing conduct, as well
DATA ANALYSIS PLAN 14

as the level of neighborhood limit which may build their entrance to care and assets (Link and

Phelan, 2002; Link and Phelan, 2005; Phelan and Link, 2005).

Wellbeing differences can take distinctive structures relying upon growth sorts that have

dependable screening devices, for example, bosom and cervical contrasted and disease sorts with

no screening apparatuses, for example, ovarian malignancy. Particular attributes and potential

elements in every progression of the infection procedure should be completely investigated,

including routine screening, follow-up of strange test outcomes, early analysis, satisfactory

treatment, and survival.

DATA ANALYSIS PLAN 15

References

American Cancer Society. Cancer Facts and Figures, 2007. Atlanta, GA: American Cancer
Society; 2007.

Bradley C, Given C, Roberts C. Disparities in cancer diagnosis and survival. Cancer.

2001;91:178–188. [PubMed]

Breastcancer.org. US breast cancer statistics. 2011 from

http://www.breastcancer.org/symptoms/understand_bc/statistics.jsp.

CDC. Breast cancer screening rates. 2011 from

http://www.cdc.gov/cancer/breast/statistics/screening.htm.

Celaya MO, Berke EM, Onega TL, Gui J, Riddle BL, Cherala SS, et al. Breast cancer stage at
diagnosis and geographic access to mammography screening (New Hampshire, 1998–
2004) Rural and Remote Health. 2010;10:1361. [PubMed]

Cho YI, Johnson TP, Barrett RE, Campbell RT, Dolecek T, Warnecke RB. Neighborhood
changes in concentrated immigration and late stage breast cancer diagnosis. Journal of
Immigrant and Minority Health. 2011;13(1):9–14. [PubMed]

Grisby P, Hall-Daniels L, Baker S, Perez C. Comparison of clinical outcomes in black and

white women treated with radiotherapy for cervical carcinoma. Gynecol Oncol.
2000;79:357–361. [PubMed]

Klinenberg E. Heat Wave: A Social Autopsy of Disaster in Chicago (Illinois) Chicago, IL:
University of Chicago Press; 2003. [PubMed]

Lundin F, Christopherson W, Mendez W, Parker J. Morbidity from cervical cancer: effects of

cervical cytology and socioeconomic status. J Natl Cancer Inst. 1965;35:1015–1025.
[PubMed]

Magai C, Consedine N, Conway F, Neugut A, Culver C. Diversity Matters: Unique populations

of women and breat cancer screening. Cancer. 2004;100(11):2300–2307. [PubMed]

National Cancer Institute. Cancer Trends Progress Report, 2009/2010 update. Bethesda, MD:
NIH, DHHS; 2010a.

Peipins L, Graham S, Young R, Lewis B, Foster S, Flanagan B, et al. Time and distance barriers
to mammography facilities in the Atlanta metropolitan area. J Community Health.
2011;36(4):675–683. [PubMed]

Phelan J, Link B. Controlling disease and creating disparities: A fundamental cause

perspective. Journals of Gerontology: Series B. 2005;60B(Special Issue II):27.
[PubMed]
DATA ANALYSIS PLAN 16

Swan J, Breen N, Coates R, Rimer B, Lee N. Progress in cancer screening practices in the
United States: results from the 2000 National Health Interview Survey. Cancer.
2003;97:1528–1540. [PubMed]