Low Rates of Cancer Screening in Rural Kentucky 141 st APHA Annual Meeting ∙ November 2013 Richard...

Low Rates of Cancer Screening in Rural Kentucky

141st APHA Annual Meeting November 2013∙

Richard CrosbyRobin Vanderpool

Bin Huang

This presentation is supported by Cooperative Agreement Number 1U48DP001932-01 from the Centers for Disease Control and Prevention (CDC). The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the CDC.

Presenter Disclosures

The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

Richard Crosby

Dr. Crosby served as a paid consultant to Merck Pharmaceuticals

UK Rural Cancer Prevention Center

The Rural Cancer Prevention Center (RCPC) is a planned collaboration of community members, public health professionals, and researchers designed to reduce health disparities associated with cervical, breast, and colorectal cancer among residents of the Kentucky River Health District in Appalachian Kentucky.

UK Rural Cancer Prevention Center

Pap Smear Screening Rates in KY 2002-2010, by Metro Status

2002 2004 2006 2008 201072

74

76

78

80

82

84

86

88

KY Metro KY Non-Metro KY

Year

Rate

Pap Smear Screening Rates in KY 2002-2010, by Appalachian Status

2002 2004 2006 2008 201070

72

74

76

78

80

82

84

86

88

KY Non-AP KY AP KY

Year

Rate

Logistic Models: Modeling Probability of Having Pap Screening while Controlling for Year and Metro/AP Status

Year in Model 1 Metro vs Non-Metro in Model 1

Year in Model 2 Non AP vs. AP in Model 2

0.8

0.9

1.0

1.1

1.2

1.3

1.4

1.5

1.6

1.7

1.8

0.8

0.9

1.0

1.1

1.2

1.3

1.4

1.5

1.6

1.7

1.8

0.96

1.35

0.96

1.48

Covariates in Model 1: Year, Metro Status; Covariates in Model 2: Year, AP Status

Odd

s Ra

to

Sigmoidoscopy & Colonoscopy Rates in KY 2002-2010, by Metro Status

2002 2004 2006 2008 201030

35

40

45

50

55

60

65

70


Year

Rate

Sigmoidoscopy & Colonoscopy Rates in KY 2002-2010, by Appalachian Status

2002 2004 2006 2008 201030

35

40

45

50

55

60

65

70

KY Non-AP KY AP KY

Year

Rate

Logistic Models: Modeling Probability of Having Sigmoidoscopy/Colonoscopy while Controlling for Year and Metro/AP Status


Year in Model 2 Non AP vs. AP in Model 21.0

1.1

1.2

1.3

1.4

1.5

1.6

1.7

1.8

1.0

1.1

1.2

1.3

1.4

1.5

1.6

1.7

1.8

1.12

1.41

1.12

1.41


Odd

s Rat

o

Mammography Screening Rates in KY 2002-2010, by Metro Status

2002 2004 2006 2008 201060

65

70

75

80

85

90


Year

Rate

Mammography Screening Rates in KY 2002-2010, by Appalachian Status

2002 2004 2006 2008 201060

65

70

75

80

85

90

KY Non-AP KY AP KY

Year

Rate

Logistic Models: Modeling Probability of Having Mammography while Controlling for Year and Metro/AP Status


Year in Model 2 Non AP vs. AP in Model 20.8

0.9

1.0

1.1

1.2

1.3

1.4

1.5

1.6

1.7

1.8

0.8

0.9

1.0

1.1

1.2

1.3

1.4

1.5

1.6

1.7

1.8

0.98

1.44

0.97

1.64


Odd

s Rat

o

Blood Stool Test Rates in KY 2002-2010, by Metro Status

2002 2004 2006 2008 201010

15

20

25

30

35

40


Year

Rate

ORs between Blood Stool Test and Metro status by Year (Metro vs Non-Metro)

2002 2004 2006 2008 20100.8

1.0

1.2

1.4

1.6

1.8

OddsRatios UpperCL LowerCL

Year

Odd

s Ra

tios

Blood Stool Test Rates in KY 2002-2010, by Appalachian Status

2002 2004 2006 2008 201010

15

20

25

30

35

40

KY Non-AP KY AP KY

Year

Rate

ORs between Blood Stool Test and AP Status by Year (Non-AP vs AP)

2002 2004 2006 2008 20100.6

0.8

1.0

1.2

1.4

1.6

1.8

OddsRatio UpperCL LowerCL

Year

Odd

s Ra

tios

Correlation between Pap Screening and Demographic - Modeling Probability of having Pap screening within the past three years

Variables Odds Ratio 95% CI p-valueYear 0.93 0.90 0.95 <0.0001

Age 0.99 0.98 0.99 <0.0001

Education

<0.0001 Reference = Less than HS

HS or GED 2.13 1.71 2.67

Education beyond HS 1.51 1.20 1.89

Income

<0.0001

Reference = less than $15,000

$15,000-$24,999 1.32 0.98 1.77

$25,000-$34,999 1.43 1.01 2.02

$35,000-$49,999 1.90 1.36 2.67

$50,000+ 3.32 2.40 4.60

Unknown 1.12 0.81 1.53

AP Status (Non AP vs AP) 1.20 1.03 1.41 0.0222

Correlation between Sigmoidoscopy/Colonoscopy and Demographic - Modeling Probability of Ever Having Sigmoidoscopy/Colonoscopy

Variables Odds Ratio 95% CI p-valueYear 1.10 1.09 1.12 <0.0001Age 1.04 1.03 1.04 <0.0001Sex (Male vs. Female) 0.81 0.74 0.88Education

<0.0001Reference = Less than HSHS or GED 1.79 1.58 2.03Education beyond HS 1.35 1.20 1.52

Income

<0.0001

Reference = less than $15,000 1.17 1.02 1.35$15,000-$24,999 1.33 1.13 1.56$25,000-$34,999 1.47 1.24 1.73$35,000-$49,999 1.99 1.71 2.32$50,000+ 1.24 1.08 1.43Unknown 1.23 1.13 1.34

Metro Status (Metro vs Non Metro) 1.23 1.13 1.34 <0.0001

Correlation between Mammography and Demographic - Modeling Probability of having Mammography within the past two years

Variables Odds Ratio 95% CI p-valueYear 1.0 0.9 1.0 <0.0001

Education

<0.0001Reference = Less than HS

HS or GED 1.8 1.6 2.1


Income

<0.0001


$15,000-$24,999 1.1 0.9 1.3

$25,000-$34,999 1.8 1.4 2.2

$35,000-$49,999 1.8 1.4 2.3

$50,000+ 2.9 2.3 3.6

Unknown 1.4 1.2 1.7

AP Status (Non AP vs AP) 1.3 1.2 1.5 <0.0001

Correlation between blood stool test and demographic - Modeling Probability of having blood stool test within the past two years

Variables Odds Ratio 95% CI p-valueYear 0.88 0.86 0.90 <.0001

Age 1.02 1.02 1.03 <.0001

Education

<.0001Reference = Less than HS

HS or GED 1.42 1.21 1.67


Income

0.003


$15,000-$24,999 1.30 1.08 1.55

$25,000-$34,999 1.33 1.09 1.63

$35,000-$49,999 1.38 1.13 1.69

$50,000+ 1.10 0.91 1.33

Unknown 1.01 0.85 1.19

Metro Status (Metro vs Non Metro) 1.14 1.03 1.26 0.011

Thank you!

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Questions?

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