Determinants of delayed detection of cancers in Texas Counties in the United States of America (International Journal for Equity in Health)

IntroductionPrevious studies have shown that delayed detection of several cancers is related tosocioeconomic deprivation as measured by the Wellbeing Index (WI) in Texas, the UnitedStates of America (USA). The current study investigates whether delayed cancer detection isrelated to lack of health insurance, physician shortage and higher percentages of Hispanicsrather than WI per se since these factors are directly related to delayed cancer detection andmay confound WI. Methods: Cancer data and potential determinants of delayed cancer detection are derived from TexasCancer Registry, Texas State Data Center, and Texas Department of State Health Servicesand U.S. Census Bureau. Texas cancer data from 1997 to 2003 are aggregated to calculateage-adjusted late- and early-stage cancer detection rates. The WI for each county is computedusing data from the USA Census 2000. A weighted Tobit regression model is used to accountfor population size and censoring. The percentage of late-stage cancer cases is the dependentvariable while independent variables include WI and the aforementioned potentialconfounders. Results: Delayed detection of breast, lung, colorectal and female genital cancers is associated withhigher percentage of uninsured residents (p < 0.05). Delayed detection is also associated withphysician shortage and lower percentages of Hispanics for certain cancers ceteris paribus (p< 0.05). The percentage of late-stage cases is positively correlated with WI for lung, andprostate cancers after adjusting for confounders (p < 0.05). Conclusions: The percentages of uninsured and Hispanic residents as well as physician supply aredeterminants of delayed detection for several cancers independently of WI, and vice versa.Identification of these determinants provides the evidence-base critical for decision makers toaddress specific issues for promoting early detection in effective cancer control.