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Individual- and Community-Level Determinants of Care Timeliness in the Carolina Breast Cancer Study
Individual- and Community-Level Determinants of Care Timeliness in the Carolina Breast Cancer Study
상세정보
- 자료유형
- 학위논문 서양
- 최종처리일시
- 20260202102949
- ISBN
- 9798315705727
- DDC
- 614
- 저자명
- Dunn, Matthew.
- 서명/저자
- Individual- and Community-Level Determinants of Care Timeliness in the Carolina Breast Cancer Study
- 발행사항
- [Sl] : The University of North Carolina at Chapel Hill, 2024
- 발행사항
- Ann Arbor : ProQuest Dissertations & Theses, 2024
- 형태사항
- 94 p
- 주기사항
- Source: Dissertations Abstracts International, Volume: 86-11, Section: B.
- 주기사항
- Advisor: Troester, Melissa A.
- 학위논문주기
- Thesis (Ph.D.)--The University of North Carolina at Chapel Hill, 2024.
- 초록/해제
- 요약Introduction: Delays in breast cancer diagnosis and treatment can lead to worse survival and quality of life. Racial disparities in care timeliness have been reported, but few studies have examined access at multiple points along the care continuum (pre-diagnosis, diagnosis, and treatment) and at multiple levels (patient, community, and health system).Methods: The Carolina Breast Cancer Study Phase 3 (CBCS3) is a population-based cohort (n=2998, 50% Black) with invasive breast cancer diagnoses (2008-2013). I used latent class analysis to group patients based on individual-level healthcare access factors (Aim 1) and to group North Carolina census tracts based on healthcare access factors (Aim 2). These latent classes were evaluated in association with 4 healthcare outcomes: delayed diagnosis (approximated with stage 3/4 at diagnosis), delayed treatment initiation (more than 30 days between diagnosis and first treatment), prolonged treatment duration (time between first and last treatment - by treatment modality), and receipt of OncotypeDx genomic testing. The community-level models were also evaluated in association with pre-diagnostic regular care and breast cancer screening. Associations were assessed with relative frequency differences (RFDs) with 95% confidence intervals (CIs). Results: Black patients had higher prevalence for each outcome. Patients with low SES and more barriers to care had greater frequency of delayed diagnosis (RFD = 5.5%, 2.4-8.5; RFD=6.7, 2.8-10.7, respectively) and prolonged treatment (RFD = 9.7%, 4.8-14.6; RFD = 7.3%, 2.4-12.2, respectively). Variable travel (short travel to diagnosis, long travel to surgery) was associated with delayed treatment (RFD = 10.7%, 2.7-18.8) compared to the short travel, high use referent group. Long travel to both diagnosis and surgery was associated with delayed treatment only among Black women. On a community-level, the low accessibility, low affordability group was associated with greater frequency of unfavorable outcomes, including under-screened (RFD= 18.6%, CI: 12.9, 24.3) and prolonged treatment (RFD=7.4%, CI: 1.9, 12.8), with similar magnitudes of effect for the high accessibility, low affordability group.Conclusions: Black patients face more frequent delays throughout the care continuum, likely stemming from different access barriers at key junctures. Improving equity in breast cancer will require addressing both individual- and community-level disparities in access.
- 일반주제명
- Health sciences
- 일반주제명
- Oncology
- 키워드
- Cancer
- 키워드
- Equity
- 키워드
- Healthcare
- 키워드
- Timeliness
- 기타저자
- The University of North Carolina at Chapel Hill Epidemiology
- 기본자료저록
- Dissertations Abstracts International. 86-11B.
- 전자적 위치 및 접속
- 로그인 후 원문을 볼 수 있습니다.
MARC
008260126s2024 us c eng d■001000017356548
■00520260202102949
■006m o d
■007cr#unu||||||||
■020 ▼a9798315705727
■035 ▼a(MiAaPQ)AAI31639582
■040 ▼aMiAaPQ▼cMiAaPQ
■0820 ▼a614
■1001 ▼aDunn, Matthew.
■24510▼aIndividual- and Community-Level Determinants of Care Timeliness in the Carolina Breast Cancer Study
■260 ▼a[Sl]▼bThe University of North Carolina at Chapel Hill▼c2024
■260 1▼aAnn Arbor▼bProQuest Dissertations & Theses▼c2024
■300 ▼a94 p
■500 ▼aSource: Dissertations Abstracts International, Volume: 86-11, Section: B.
■500 ▼aAdvisor: Troester, Melissa A.
■5021 ▼aThesis (Ph.D.)--The University of North Carolina at Chapel Hill, 2024.
■520 ▼aIntroduction: Delays in breast cancer diagnosis and treatment can lead to worse survival and quality of life. Racial disparities in care timeliness have been reported, but few studies have examined access at multiple points along the care continuum (pre-diagnosis, diagnosis, and treatment) and at multiple levels (patient, community, and health system).Methods: The Carolina Breast Cancer Study Phase 3 (CBCS3) is a population-based cohort (n=2998, 50% Black) with invasive breast cancer diagnoses (2008-2013). I used latent class analysis to group patients based on individual-level healthcare access factors (Aim 1) and to group North Carolina census tracts based on healthcare access factors (Aim 2). These latent classes were evaluated in association with 4 healthcare outcomes: delayed diagnosis (approximated with stage 3/4 at diagnosis), delayed treatment initiation (more than 30 days between diagnosis and first treatment), prolonged treatment duration (time between first and last treatment - by treatment modality), and receipt of OncotypeDx genomic testing. The community-level models were also evaluated in association with pre-diagnostic regular care and breast cancer screening. Associations were assessed with relative frequency differences (RFDs) with 95% confidence intervals (CIs). Results: Black patients had higher prevalence for each outcome. Patients with low SES and more barriers to care had greater frequency of delayed diagnosis (RFD = 5.5%, 2.4-8.5; RFD=6.7, 2.8-10.7, respectively) and prolonged treatment (RFD = 9.7%, 4.8-14.6; RFD = 7.3%, 2.4-12.2, respectively). Variable travel (short travel to diagnosis, long travel to surgery) was associated with delayed treatment (RFD = 10.7%, 2.7-18.8) compared to the short travel, high use referent group. Long travel to both diagnosis and surgery was associated with delayed treatment only among Black women. On a community-level, the low accessibility, low affordability group was associated with greater frequency of unfavorable outcomes, including under-screened (RFD= 18.6%, CI: 12.9, 24.3) and prolonged treatment (RFD=7.4%, CI: 1.9, 12.8), with similar magnitudes of effect for the high accessibility, low affordability group.Conclusions: Black patients face more frequent delays throughout the care continuum, likely stemming from different access barriers at key junctures. Improving equity in breast cancer will require addressing both individual- and community-level disparities in access.
■590 ▼aSchool code: 0153.
■650 4▼aHealth sciences
■650 4▼aOncology
■653 ▼aCancer
■653 ▼aRacial disparities
■653 ▼aEquity
■653 ▼aHealthcare
■653 ▼aTimeliness
■690 ▼a0566
■690 ▼a0992
■690 ▼a0769
■71020▼aThe University of North Carolina at Chapel Hill▼bEpidemiology.
■7730 ▼tDissertations Abstracts International▼g86-11B.
■790 ▼a0153
■791 ▼aPh.D.
■792 ▼a2024
■793 ▼aEnglish
■85640▼uhttp://www.riss.kr/pdu/ddodLink.do?id=T17356548▼nKERIS▼z이 자료의 원문은 한국교육학술정보원에서 제공합니다.
