A survey of stomach and kidney cancer patients in Los Angeles revealed that those who were diagnosed in a late stage of disease ? when cancer is harder to treat successfully ? were likely to be older, living in an unsafe neighborhood and traveling at least 45 minutes to get to the doctor.
Researchers at the University of Southern California’s Keck School of Medicine cite two general types of personal risk factors associated with late cancer diagnosis: socio-economic, or cultural, factors related to knowledge about the health care system and difficulties accessing it; and individuals’ failure to give priority to medical care, despite having access to it.
While minorities have been shown to have higher rates of dying from cancer, it hasn’t always been clear why, said Ann Hamilton, Ph.D., assistant professor of preventive medicine at USC. Using proportions of minorities in census tracts or income and education statistics hasn’t been totally effective in identifying subgroups at higher risk.
Hamilton and USC colleague Myles Cockburn mailed a questionnaire to patients diagnosed with stomach and kidney cancer between 2000 and 2001 in Los Angeles County, which has a large Hispanic population. It asked about, among other things, access to care, acculturation, neighborhood environment, other diseases and demographic information. The acculturation scale was based on a series of questions, such as, ?What language do you speak primarily at home ? English, Spanish or both?’
Hamilton and Cockburn also wanted to identify “neighborhood-related” factors that could help predict population subgroups at higher risk for being diagnosed late, in addition to personal risk factors. “I wanted to identify new combinations of individual risk factors as well as ecological factors at the census tract level that could be used to better predict subgroups at higher risk,” Hamilton said.
The researchers found that, at the census tract level, the percentage of people who speak a language other than English at home, the percentage of Hispanics 25 or older with less than a ninth grade education, percent unemployed and percent using public transportation were correlated with a higher percentage of cancers being diagnosed at a later stage.
“In using both ecological and personal measures, we were trying to determine how both factors may increase risk. We were assessing the effect of personal risk factors in the context of the neighborhood environment,” Hamilton said. “For example, we found an indication that after taking other factors into account, a person with a lower level of acculturation who lived in an area where few others speak English was more likely to be diagnosed at a later stage of disease than the same type of person who lived in an area where most spoke English.”
The results, Hamilton said, may help better target disease intervention programs for those most vulnerable and at risk.