California Medicaid enrollment and melanoma stage at diagnosis: a population-based study

BACKGROUND: Insurance status and SES are associated with the stage of melanoma at diagnosis. However, the influence of Medicaid enrollment on melanoma stage has not been studied in detail. This study examined the effect of Medicaid enrollment status and duration on melanoma stage at diagnosis in a large, multi-ethnic California population. METHODS: California Cancer Registry records were linked with statewide Medicaid enrollment files to identify 4558 men and women diagnosed with invasive cutaneous and metastatic melanoma during 1998-1999. Multivariate logistic regression was used to evaluate the association between prediagnosis Medicaid enrollment status and late-stage diagnosis and tumor depth at diagnosis. RESULTS: Late-stage disease was diagnosed in 27% of Medicaid and 9% of non-Medicaid melanoma patients. Those enrolled in Medicaid at diagnosis and those enrolled intermittently during the year prior to diagnosis had significantly greater covariate-adjusted odds of late-stage cancer than those not enrolled in Medicaid (OR 13.64, 95% CI=4.43, 41.98, and OR 2.77, 95% CI=1.28, 5.99, respectively). Participants continuously enrolled during the previous year were not at increased odds for late-stage disease. An increased likelihood of late-stage melanoma was also associated with low SES (p<0.05) and non-Hispanic black race/ethnicity (p<0.10) after covariate adjustment. CONCLUSIONS: Men and women intermittently enrolled in Medicaid or not enrolled until the month of diagnosis had a significantly increased likelihood of late-stage melanoma. Greater education and outreach, particularly in low-SES areas, are needed to improve melanoma awareness and access to screening.     

Cutaneous melanoma: diagnosis and at risk patients

Malignant melanoma is a condition which kills many young people, yet early recognition can lead to cure. There are, however, new approaches to diagnosis and management of disease at high risk of recurrence, which raise glimmers of hope in this most capricious of conditions.     

Demographic predictors of mammography and Pap smear screening in US women.

OBJECTIVES. Proven screening technologies exist for both breast and cervical cancer, but they are underused by many women. We sought to evaluate the effect of demographic characteristics on the underuse of mammography and Pap smear screening. METHODS. We analyzed responses from 12,252 women who participated in the 1987 National Health Interview Survey Cancer Control Supplement. Demographic profiles were produced to target severely underserved groups of women. RESULTS. Low income was a strong predictor of mammography underuse, as was Hispanic ethnicity and other race, low educational attainment, age greater than 65, and residence in a rural area. A strong predictor of never having had a Pap smear was never having been married; however, the importance of this characteristic is difficult to interpret in the absence of data on sexual activity. Hispanic women and women of other races of all ages and all income levels underused Pap smear screening, as did older women, particularly older Black women. CONCLUSIONS. The tendency of women to underuse screening technologies varies greatly across levels of basic demographic characteristics. The importance of these characteristics differs for mammography screening versus Pap smear screening.     

Demographic chic at the UN

Anti-Malthusian rhetoric is again popular. Nonsocialist intellectuals as well as socialists are saying that poverty, not population, is the problem. There is a need for population programs. A recent survey in 16 developing countries indicated that after 3 children 50% of the couples wanted no more, after 4, 70% wanted no more. There is no necessity to choose between development and population programs; there is room for both. Considering the limited amount of money that has been spent on population programs, it is unfair to say, as the new demographic chic does, that family planning has failed. More resources, better management, and extensive research are needed to make family planning really effective. It is easier to achieve than most of the developmental items the demographic chic spokesmen are demanding.     

Impact of socioeconomic status on stage at diagnosis of breast cancer

BackgroundThis study aimed to evaluate the potential impact of social inequalities on stage at diagnosis and long-term outcome of breast cancer patients attending the Institut Curie in Paris (France).MethodsThe study population included 14,610 breast cancer patients diagnosed and treated in the Institut Curie between 1981 and 2001. The socioeconomic status was determined from district of residence, median income for town of residence corrected by the consumption unit and body mass index. Logistic regression models adjusted on socioeconomic factors were used to evaluate clinical and pathologic features at diagnosis. Overall survival and distant metastasis were analysed with log-rank tests and Cox proportional hazards regression models.ResultsPatients living in lower income districts were more likely to be diagnosed with breast tumors size greater than 20 mm (P = 0.01). Residents of high-income urban areas (> 15,770 €) exhibited a significant overall survival and distant metastasis advantage (respectively HR = 0.93 [0.86–0.99]; P = 0.02 and HR = 0.91 [0.85–0.98]; P = 0.01). Breast cancer screening with mammography was independent of district of residence (P = 0.61) or income (P = 0.14). After adjusting for age at diagnosis and period, the risk of having breast cancer with unfavorable prognostic factors such as tumor size greater than 20 mm decreased with 1000 € increase in district income (OR = 0.986 [0.98–0.99]; P < 0.001). Similarly, the risk of cancer death decreased for patients residing in districts with median income greater than 15,770 € (HR = 0.92 [0.86–0.98]; P = 0.01).ConclusionDespite the limitations of the study (aggregate data used to assess socioeconomic status, non representative cohort of French women), we observed that poorer breast cancer prognosis with advanced disease diagnosis and increased risk of breast cancer mortality was related to low socioeconomic status.     

子宫颈癌早诊早治项目结果分析

目的：了解育龄妇女癌症综合知识和子宫颈癌防治知识的知晓情况,推广适宜农村地区的子宫颈癌筛查方法,促进子宫颈癌早诊早治,降低子宫颈癌的发病率和死亡率。方法：以35-55岁已婚妇女作为对象,进行以人群为基础的子宫颈癌筛查。对符合条件的妇女进行癌症综合知识及子宫颈癌防治知识知晓情况的问卷调查。受检妇女使用5％醋酸染色后肉眼观察（VIA）和2％碘染色后肉眼观察（VILI）宫颈改变,结果异常者进行阴道镜下活检并得到最终的病理学诊断。结果：有效问卷2029份,显示对吸烟、饮酒是癌症的主要危险因素等知晓率较高;而癌症的大多数危险因素、早诊早治方法和子宫颈癌的预防控制措施等许多方面知晓率较低。不同教育背景及不同年龄的知晓率存在较大差异,学历高、年龄轻的妇女知晓率高。2008年筛查适龄妇女2029人,96人采集了病理标本,最终病理确诊CINI（轻度宫颈上皮内瘤变）4人,CINⅡ（中度宫颈上皮内瘤变）1人,CINⅢ（重度宫颈上皮内瘤变）／原位癌1人,早期浸润癌1人。≥CINⅡ的检出率为1．48‰≥CIN总人数为7人,占VIA和VILI阳性人数的4．52％。2009年复查1760人,50人采集了病理标本,最终病理确诊CINI11人,CINⅡ2人,≥CINⅡ的现患率为l_14％o。≥CIN总人数为13人,占VIA和VII．I阳性人数的12．26％。两年累计检出≥CINⅡ5人,累计≥CINⅡ的检出率为2．46‰。结论：大丰市要针对不同对象进一步加大妇女生殖健康的宣传力度,积极开展预防子宫颈癌的健康教育,提高人群的癌症防治知识知晓率,同时有关部门应不断提高筛查水平,做到子宫颈癌的早发现、早诊断、早治疗。     

Demographic profile and predictors of unmet need for family planning among Jordanian women

BACKGROUND: Despite a reduction in fertility rates and a rise in the prevalence of contraceptive use in Jordan, a gap still exists between women's knowledge of family planning methods and actual usage of these methods. The study aimed to measure the prevalence of unmet need, describe the main socioeconomic characteristics, and outline the predictors of unmet need. METHODS: A nationally representative sample of 2406 women using Ministry of Health facilities was obtained by applying a two-stage cluster sampling technique. Six strata were identified based on three geographical regions and two types of health centre. RESULTS: The study results demonstrate the overall prevalence of unmet need to be 16.3%, comprising 6.8% of women who wanted to limit births and 9.5% who wanted to space births. A negative significant correlation was found between unmet need and the women's educational level. There was a higher level of unmet need in the south compared to other regions. Women's age categories showed high unmet need in the young and old categories compared to the middle age category of 25-35 years of age. A similar pattern was also seen when the number of living children was considered. CONCLUSIONS: The study results indicate that lowering the prevalence of unmet need in Jordan is dependent on reducing the knowledge gap, since unmet need is related to women's level of education. Improving access to services at the regional level is also a key factor in reducing disparities between geographical regions.     

Demographic factors as predictors for hospital admission in patients with chronic disease

OBJECTIVE: To identify demographic predictors of hospital admission for chronic disease. METHODS: Hospital morbidity records were extracted from the WA Data Linkage System for the period 1994-99 for specific chronic diseases based on national priorities. Poisson regression was used to estimate the effects of Aboriginal and Torres Strait Islander (ATSI) descent, co-morbidity, geography, socio-economic status and possession of health insurance on hospital admission rates. RESULTS: This study has identified some of the main demographic risk factors for hospitalisation in patients with chronic disease as the following: being male, of ATSI descent, living in a relatively disadvantaged Census Collection District and having multiple co-morbidities. Depending on the disease, locational disadvantage and possession of private health insurance were also risk factors. CONCLUSIONS: The study indicates that a crucial component in keeping patients with chronic disease out of hospital is ensuring quality primary care for all members of the community, equipping patients with the necessary skills to self-manage their chronic condition. Particular attention must be given to developing programs that are accessible to the more disadvantaged members of the community. IMPLICATIONS: Programs aimed at keeping patients with chronic disease out of hospital must be targeted at the most vulnerable groups of the population if they are to be effective.     

Demographic and dietary predictors of urinary bisphenol A concentrations in adults in Israel

Background

To date, there is scarce data on levels of exposure to bisphenol A (BPA) in the general population in Israel and the region. The goal of the current study was to measure urinary levels of BPA in the general adult population in Israel and to determine the demographic and dietary predictors of exposure.

Methods

We recruited 249 individuals (ages 20–74) from five different regions in Israel. We collected urine samples and questionnaire data including detailed dietary data and analyzed urine samples for BPA concentrations.

Results

Eighty nine percent of the study population had urinary BPA concentrations equal to or above the level of quantification (0.3 μg/L). Median creatinine adjusted BPA urinary concentrations in the study population (2.3 μg/g) were slightly higher than those reported for the general population in the US (1.76 μg/g) and Canada (1.47 μg/g), and were comparable to those reported for the general population in Belgium (2.25 μg/g) and Korea (2.09 μg/g). BPA concentrations were higher in Jews compared to Arab and Druze (prevalence ratio (PR) = 2.34; 95%CI 1.56–3.49), in individuals with higher education (PR = 1.70, 1.11–2.62), in individuals consuming mushrooms (PR = 2.08, 1.07–4.05), and in smokers (PR = 1.43, 1.00–2.05).

Conclusions

We found that the general adult population in Israel is widely exposed to BPA. Our findings on higher BPA levels in Jews compared to Arabs and Druze and in individuals with higher education highlights the fact that predictors of BPA exposure vary across populations.     

Race, anthropometric factors, and stage at diagnosis of breast cancer

A recent study suggested that the greater prevalence of severe obesity among African-American women explained almost one third of the observed differences between African-American and White women in stage at diagnosis of breast cancer. The objective of this investigation was to attempt to replicate these findings in a second, larger population and to expand the analyses by including a measure of body fat distribution, the waist:hip ratio. The authors used data from a population-based study in North Carolina comprising 791 breast cancer cases (302 in African-American women and 489 in White women) diagnosed between 1993 and 1996. African-American women were more likely to have later-stage (TNM stage >/=II) breast cancer (odds ratio (OR) = 2.2; 95% confidence interval (CI): 1.6, 2.9). They also were much more likely to be severely obese (body mass index >/=32.3) (OR = 9.7; 95% CI: 6.5, 14.5) and to be in the highest tertile of waist:hip ratio (OR = 5.7; 95% CI: 3.8, 8.6). In multivariate logistic regression models, adjustment for waist:hip ratio reduced the odds ratio for later-stage disease in African-American women by 20%; adjustment for both waist:hip ratio and severe obesity reduced the odds ratio by 27%. These observations suggest that obesity and body fat distribution, in addition to socioeconomic and medical care factors, contribute to racial differences in stage at breast cancer diagnosis.     

Patients at elevated risk of melanoma: Individual predictors of non-compliance to GP referral for a dermatologist consultation

ObjectiveThe aim of this study is to assess whether patients at elevated risk of melanoma attended a dermatologist consultation after a General Practitioner referral and to determine individual predictors of non-compliance.MethodThis survey included 1506 high-risk French patients (selected using the Self-Assessment Melanoma Risk Score) referred to a dermatologist between April and October 2011.Compliance was evaluated from January to April 2012, based on attendance at a dermatologist consultation (or scheduling an appointment).Demographic data and factors mapping the Health Belief Model were tested as correlates using a multivariate logistic regression.ResultsCompliance with referral was 58.4%. The top seven factors associated with non-compliance were as follows: GP advice to consult was unclear (OR = 13.22; [7.66–23.56]); no previous participation in cancer screenings, including smear tests (OR = 5.03; [2.23–11.83]) and prostate screening (OR = 2.04; [1.06–3.97]); lack of knowledge that melanoma was a type of cancer (OR = 1.94; [1.29–2.92]); and reporting no time to make an appointment (OR = 2.08; [1.82–2.38]), forgetting to make an appointment (OR = 1.26; [1.08–1.46]), long delays in accessing an appointment (OR = 1.25; [1.12–1.41]), not being afraid of detecting something abnormal (OR = 1.54; [1.35–1.78]), no need to consult a dermatologist to feel secure (OR = 1.28; [1.09–1.51]).ConclusionPhysicians should be aware of the factors predicting patient compliance with referrals for dermatologist consultations; better General Practitioner counseling might enhance compliance in high-risk populations.     

Demographic predictors of cancer screening among Filipino and Korean immigrants in the United States

BACKGROUND: Little is known about cancer-screening practices of various Asian subgroups, and even less is known about factors that may predict screening in these populations. DESIGN: Two independent surveys were conducted with 218 Filipino and 229 Korean female immigrants, aged 50 years and older, residing in Los Angeles. RESULTS: In these convenience samples, 48% of Filipino and 41% of Korean women reported receipt of a Pap smear within the past 2 years; 41% of Filipino and 25% of Korean women reported receipt of a mammogram and a clinical breast exam within the past 2 years; and 25% of Filipino and 38% of Korean women reported colorectal cancer screening (blood stool test within the past 12 months or sigmoidoscopy/colonoscopy within the past 5 years). Only 14% of Filipino and 10% of Korean women were adherent to cancer-screening guidelines for all three sites. These differences in screening rates were statistically significant in multivariate analyses of the combined sample, controlling for all demographic characteristics, including age, percent of lifetime in the United States, education, marital status, health insurance, employment, and ethnicity. The two variables that were most consistently independently associated with adherence to cancer screening in both samples were higher percentage of lifetime spent in the United States and ever having had a checkup when no symptoms were present. CONCLUSIONS: These two variables-percent of lifetime in the United States and ever having had a checkup when no symptoms were present-can alert a physician that cancer-screening tests may be overdue among Korean and Filipino immigrants in the United States. Future research should identify predictors of cancer screening among other Asian immigrant groups and U.S.-born Asian women to assist in targeting intervention efforts.     

Urinary concentrations of polycyclic aromatic hydrocarbons in Israeli adults: Demographic and life-style predictors

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental pollutants associated with adverse health outcomes, including cancer, asthma, and reduced fertility. Because data on exposure to these contaminants in Israel and the Middle East are very limited this study was conducted to measure urinary levels of PAHs in the general adult population in Israel and to identify demographic and life-style predictors of exposure.We measured concentrations of five PAH metabolites: 1-hydroxypyrene (1OH_pyrene) and four different hydroxyphenanthrenes (1-hydroxyphenanthrene, 2-hydroxyphenanthrene, 3-hydroxyphenanthrene, 4-hydroxyphenanthrene), as well as cotinine in urine samples collected from 243 Israeli adults from the general population. We interviewed participants using structured questionnaires to collect detailed demographic, smoking and dietary data. For over 99% of the study participants, urinary concentration of at least one of the PAHs was above both the limit of detection (LOD) and the limit of quantification (LOQ). All PAHs were significantly correlated (rho = 0.67–0.92). Urinary concentration of hydroxyphenanthrenes, but not 1OH_pyrene, was significantly higher among Arabs and Druze study participants (N = 56) compared to Jewish participants (N = 183). For 4-hydroxyphenanthrene, concentration in Arabs and Druze was 1.95 (95% CI 1.50–2.52) that of Jews, after controlling for creatinine, age and cotinine levels. Urinary concentrations of all PAHs were significantly higher among current smokers or participants with higher cotinine levels and increased significantly with smoking frequency. While PAHs concentrations were not associated with cotinine concentrations in nonsmokers in the overall study population, PAHs concentration was significantly higher among nonsmoking Jews with cotinine ≥LOQ (1 μg/L), which represents exposure to environmental tobacco smoking, compared to nonsmoking Jews with cotinine concentrations <LOQ, with the highest ratio for 1OH_pyrene (Ratio = 2.38, 95% CI 1.47–3.85). Among nonsmoking Arabs and Druze, higher hydroxyphenanthrenes concentrations were found for those consuming grilled food once a month or more. For 3-hydroxyphenanthrene, concentration in those consuming grilled food once a month or more was 2.72 (95% CI 1.01–4.98) times that of those consuming grilled food less than once a month or not at all, after controlling for creatinine, age and cotinine levels.In conclusion, we found that the general adult population in Israel is widely exposed to PAHs. Exposure differed by ethnic sub-groups both in magnitude and sources of exposure. The finding of higher exposure among Arabs and Druze highlights disparities in environmental exposures across subpopulations and suggests that further research and preventive measure are warranted to reduce PAHs exposure and associated health outcomes, especially in the Arab population in the Middle East.     

Colorectal cancer stage at diagnosis and area socioeconomic characteristics in New Jersey

Despite effective screening methods, research suggests consistently higher rates of late stage colorectal cancer (CRC) among persons living in low socioeconomic areas compared to those living in affluent areas. This population-based study evaluated the association between area-based socioeconomic measures (ABSMs) and CRC stage at diagnosis in New Jersey. Cases of CRC among persons 50 years and older, diagnosed from 2000–2005, were obtained from the New Jersey State Cancer Registry. Associations between census tract-level ABSMs and CRC stage at diagnosis were evaluated using logistic regression and geographic variation assessed using a spatial scan statistic. After adjusting for covariates, including individual-level health insurance, ABSMs were significantly associated with stage at diagnosis. As area socioeconomic conditions worsened, the odds of being diagnosed at a late stage increased. While increasing CRC screening services for all New Jersey populations is warranted, this study suggests that persons living in low socioeconomic areas could benefit the most from enhanced CRC education, screening efforts, and guided interventions.     

The role of area-level influences on prostate cancer grade and stage at diagnosis

BACKGROUND: This research explores area-level social influences on prostate cancer, to test whether area-level influences explain disparities in U.S. prostate cancer burden. METHODS: The authors geocoded 23,993 1992-1997 Maryland prostate cancer cases, and linked cases to 1990 census data. The authors examined the effect of 17 area-level social variables, measured at block group, tract, and county, modeling individual and multilevel predictors of later stage and higher tumor grade. RESULTS: Younger age, black race, higher grade or ungraded tumors, and earlier year of diagnosis were associated with later stage. Block group percentage of white-collar workers (O.R. = 0.93, 95% C.I. = 0.89, 0.98), and county resources (O.R. = 0.94, 95% C.I. = 0.89, 0.98), were protective of later stage. Older age, black race, and earlier year of diagnosis were associated with higher grade. Block group income was protective for white men (O.R. = 0.92, 95% C.I. = 0.87, 0.96), but for all men, county resources increased risk of higher grade (O.R. = 1.23, 95% C.I. = 1.16, 1.31). CONCLUSIONS: Social resources did not significantly reduce racial differences. Results suggest tumor biology is related to relative resources, with better outcomes associated with greater small-area wealth in low-resource counties, but stage at diagnosis is associated with absolute resources, with better outcomes associated with higher small-area social class in high-resource counties.