Abstract
Late-stage breast cancer diagnosis is common for women of color even though cancer screening rates in this group have increased over time. Perceived medical discrimination from health care providers is a key culprit of this inconsistency, discouraging women of color from seeking out timely preventative care. Non-white neighborhoods offer social support structures that mitigate discrimination. However, it is not clear whether this mitigation applies to the chance women of color get timely mammograms. This study addresses that question, applying Hierarchical Linear Modeling methods onto the Public Health Management Corporation’s 2006 and 2008 survey, as well as the 2005–2009 American Community Survey. Findings indicate that while neighborhood racial/ethnic composition does not directly reduce medical discrimination’s association to screening, factors closely connected to place, like health care access, do have a mitigating influence on this association. Also, neighborhood racial/ethnic composition and social support have a positive direct relation with screening.
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Abramson, C. M., Hashemi, M., & Sanchez-Jankowski, M. (2015). Perceived discrimination in U.S. healthcare: Charting the effects of key social characteristics within and across racial groups. Preventive Medicine Reports, 2, 615–621. https://doi.org/10.1016/j.pmedr.2015.07.006.
Ahern, M. M., & Hendryx, M. S. (2003). Social capital and trust in providers. Social Science & Medicine, 57(7), 1195–1203. https://doi.org/10.1016/S0277-9536(02)00494-X.
Alford-Teaster, J., Lange, J. M., Hubbard, R. A., Lee, C. I., Haas, J. S., Shi, X., et al. (2016). Is the closest facility the one actually used? An assessment of travel time estimation based on mammography facilities. International Journal of Health Geographics, 15(8), 1–10. https://doi.org/10.1186/s12942-016-0039-7.
Allport, G. (1954). The nature of prejudice. Cambridge, MA: Perseus Books.
American Cancer Society. (2014). “Breast cancer survival rates by stage.” 2014. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-survival-by-stage.
American Cancer Society. (2016). “Breast cancer facts and figures for Hispanics/Latinos 2015–2017.” 2016. http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-046405.pdf.
American Cancer Society. (2019). Breast cancer facts & figures. Atlanta, GA: American Cancer Society.
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1. https://doi.org/10.2307/2137284.
Babitsch, B., Gohl D., & von Lengerke, T. (2012). Re-revisiting Andersen’s behavioral model of health services use: A systematic review of studies from 1998–2011. GMS Psycho-Social-Medicine 9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488807/.
Bécares, L., & Nazroo, J. (2013). Social capital, ethnic density and mental health among ethnic minority people in England: A mixed-methods study. Ethnicity & Health, 18, 544–562.
Benjamins, M. R. (2006). Religious influences on trust in physicians and the health care system. The International Journal of Psychiatry in Medicine, 36(1), 69–83.
Blair, I. V., Steiner, J. F., Fairclough, D. L., Hanratty, R., Price, D. W., Hirsh, H. K., et al. (2013). Clinicians’ implicit ethnic/racial bias and perceptions of care among black and Latino patients. The Annals of Family Medicine, 11(1), 43–52. https://doi.org/10.1370/afm.1442.
Boulware, L. E., Cooper, L. A., Ratner, L. E., LaVeist, T. A., & Powe, N. R. (2003). Race and trust in the health care system. Public Health Reports, 118(4), 358.
Brach, C., & Fraserirector, I. (2000). Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Medical Care Research and Review, 57(4 suppl), 181–217.
Center for Disease Control. (2017). “500 cities: Local data for better health.” Atlanta, GA. https://www.cdc.gov/500cities/.
Centers for Disease Control and Prevention. (2020). “USCS data visualizations.” United States cancer statistics data visualizations. 2020. https://gis.cdc.gov/grasp/USCS/DataViz.html.
Christensen, M. A. (2019). Feminization of poverty: Causes and implications. In F. W. Leal, A. Azul, L. Brandli, P. Özuyar, & T. Wall (Eds.), Gender equality (pp. 1–10). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-319-70060-1_6-1.
Cooper, L. A., Roter, D. L., Carson, K. A., Beach, M. C., Sabin, J. A., Greenwald, A. G., & Inui, T. S. (2012). The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. American Journal of Public Health, 102(5), 979–987.
Dean, L. T., Subramanian, S. V., Williams, D. R., Armstrong, K., Charles, C. Z., & Kawachi, I. (2014). The role of social capital in African-American women’s use of mammography. Social Science & Medicine, 104(March), 148–156. https://doi.org/10.1016/j.socscimed.2013.11.057.
Doescher, M. P., Saver, B. G., Fiscella, S., & Franks, P. (2001). Racial/ethnic inequities in continuity and site of care: Location, location, location. HSR: Health Services Research, 36(6), 78-89:
Enos, R. (2017). The space between us: Social geography and politics. Cambridge: Cambridge University Press. https://doi.org/10.1017/9781108354943.
Forrest, C. B., & Whelan, E.-M. (2000). Primary care safety-net delivery sites in the United States. A comparison of community health centers, hospital outpatient departments, and physicians’ offices. The Journal of the American Medical Association, 284(16), 2077–2083. https://doi.org/10.1001/jama.284.16.2077.
Friedman, S. (2008). Do declines in residential segregation mean stable neighborhood racial integration in metropolitan America? A research note. Social Science Research, 37(3), 920–933. https://doi.org/10.1016/j.ssresearch.2007.06.010.
Gamble, V. N. (1997). Under the shadow of Tuskegee: African Americans and health care. American Journal of Public Health, 87(11), 1773–1778.
Gee, G. C. (2002). A multilevel analysis of the relationship between institutional and individual racial discrimination and health status. American Journal of Public Health, 92(4), 615–623.
Gibbons, J. R. (2019). The effect of segregated cities on ethnoracial minority healthcare system distrust. City & Community, 18(1), 321–343. https://doi.org/10.1111/cico.12370.
Gibbons, J. R., & Schiaffino, M. K. (2016). Determining the spatial heterogeneity underlying racial and ethnic differences in timely mammography screening. International Journal of Health Geographics. https://doi.org/10.1186/s12942-016-0067-3.
Gibbons, J. R., & Yang, T. C. (2014). Self-rated health and residential segregation: How does race/ethnicity matter? Journal of Urban Health, 91(4), 648–660. https://doi.org/10.1007/s11524-013-9863-2.
Gibbons, J. R., & Yang, T. C. (2016). Connecting across the divides of race/ethnicity how does segregation matter? Urban Affairs Review, 52(4), 531–558.
Gibbons, J. R., & Yang, T. C. (2018). Searching for silver linings: Is perceived medical discrimination weaker in segregated areas? Applied Spatial Analysis and Policy, 11(1), 37–58. https://doi.org/10.1007/s12061-016-9211-5.
Goyal, M. K., Kuppermann, N., Cleary, S. D., Teach, S. J., & Chamberlain, J. M. (2015). Racial disparities in pain management of children with appendicitis in emergency department. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2015.1915.
Greene, J., Blustein, J. A. N., & Weitzman, B. C. (2006). Race, segregation, and physicians’ participation in Medicaid. Milbank Quarterly, 84(2), 239–272.
Hausmann, L. R., Jeong, K., Bost, J. E., & Ibrahim, S. A. (2008). Perceived discrimination in health care and use of preventive health services. Journal of General Internal Medicine, 23(10), 1679–1684. https://doi.org/10.1007/s11606-008-0730-x.
Huang, B., Dignan, M., Han, D., & Johnson, O. (2009). Does distance matter? Distance to mammography facilities and stage at diagnosis of breast cancer in Kentucky. The Journal of Rural Health, 25(4), 366–371.
Hunt, M. O., Wise, L. A., Jipguep, M.-C., Cozier, Y. C., & Rosenberg, L. (2007). Neighborhood racial composition and perceptions of racial discrimination: Evidence from the black women’s health study. Social Psychology Quarterly, 70(3), 272–289.
Hutchinson, R. N., Putt, M. A., Dean, L. T., Long, J. A., Montagnet, C. A., & Armstrong, K. (2009). Neighborhood racial composition, social capital and black all-cause mortality in Philadelphia. Social Science & Medicine, 68(10), 1859–1865. https://doi.org/10.1016/j.socscimed.2009.02.005.
Iqbal, J., Ginsburg, O., Rochon, P. A., Sun, P., & Narod, S. A. (2015). Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States. JAMA, 313(2), 165–173. https://doi.org/10.1001/jama.2014.17322.
Jacobs, E. A., Rathouz, P. J., Karavolos, K., Everson-Rose, S. A., Janssen, I., Kravitz, H. M., et al. (2014). Perceived discrimination is associated with reduced breast and cervical cancer screening: The study of women’s health across the nation (SWAN). Journal of Womens Health (Larchmt), 23(2), 138–145. https://doi.org/10.1089/jwh.2013.4328.
Johnson, R. L. (2004). Patient race/ethnicity and quality of patient–physician communication during medical visits. American Journal of Public Health, 94(12), 2084–2090.
Kessler, R. C., Mickelson, K. D., & Williams, D. R. (1999). The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. Journal of Health and Social Behavior, 40(September), 208–230.
Khan-Gates, J. A., Ersek, J. L., Eberth, J. M., Adams, S. A., & Pruitt, S. L. (2015). Geographic access to mammography and its relationship to breast cancer screening and stage at diagnosis: A systematic review. Women’s Health Issues, 25(5), 482–493. https://doi.org/10.1016/j.whi.2015.05.010.
Kim, D. (2006). Bonding versus bridging social capital and their associations with self rated health: A multilevel analysis of 40 US communities. Journal of Epidemiology & Community Health, 60(2), 116–122. https://doi.org/10.1136/jech.2005.038281.
Kutner, M. H., Nachtsheim, C. J., Neter, J., & Li, W. (2005). Applied linear statistical models. The McGraw-Hill/Irwin series operations and decision sciences (5th ed.). Boston: McGraw-Hill Irwin.
Massey, D. S., & Denton, N. A. (1988). The dimensions of residential segregation. Social Forces, 67(2), 281. https://doi.org/10.2307/2579183.
Massey, D. S., & Denton, N. A. (1993). American apartheid: Segregation and the making of the underclass. Cambridge, MA: Harvard University Press.
McKenzie, B. S. (2013). Neighborhood access to transit by race, ethnicity, and poverty in Portland, OR: NEIGHBORHOOD ACCESS TO TRANSIT. City & Community, 12(2), 134–155. https://doi.org/10.1111/cico.12022.
McRoberts, O. M. (2003). Streets of glory: Church and community in a black urban neighborhood. Chicago: University of Chicago Press.
Mejia de Grubb, M. C., Kilbourne, B., Kihlberg, C., & Levine, R. S. (2013). Demographic and geographic variations in breast cancer mortality among U.S. Hispanics. Journal of Health Care for the Poor and Underserved, 24(1 Suppl), 140–152. https://doi.org/10.1353/hpu.2013.0043.
Miller, S. (2012). The effect of insurance on emergency room visits: An analysis of the 2006 Massachusetts Health Reform. Journal of Public Economics, 96(11), 893–908. https://doi.org/10.1016/j.jpubeco.2012.07.004.
Molina, Y., Plascak, J. J., Patrick, D. L., Bishop, S., Coronado, G. D., & Beresford, S. A. A. (2017). Neighborhood predictors of mammography barriers among US-based Latinas. Journal of Racial and Ethnic Health Disparities, 4(2), 233–242. https://doi.org/10.1007/s40615-016-0222-3.
Onega, T., Cook, A., Kirlin, B., Shi, X., Alford-Teaster, J., Tuzzio, L., & Buist, D. S. M. (2011). The influence of travel time on breast cancer characteristics, receipt of primary therapy, and surveillance mammography. Breast Cancer Research and Treatment, 129(1), 269–275. https://doi.org/10.1007/s10549-011-1549-4.
PHMC. (2008). 2008 Household Health Survey Documentation. Philadelphia: Public Health Management Corporation.
Pickett, K. E., & Wilkinson, R. G. (2008). People like us: Ethnic group density effects on health. Ethnicity & Health, 13(4), 321–334. https://doi.org/10.1080/13557850701882928.
Putnam, R. D. (2000). Bowling alone: The collapse and revival of American community. New York: Simon & Schuster.
Radecki, S. E., & Bernstein, G. S. (1989). Use of clinic versus private family planning care by low-income women: Access, cost, and patient satisfaction. American Journal of Public Health, 79(6), 692–697.
Ray, R. (2014). An intersectional analysis to explaining a lack of physical activity among middle class black women: Intersectionality, physical activity, and middle class black women. Sociology Compass, 8(6), 780–791. https://doi.org/10.1111/soc4.12172.
Sampson, R. J. (2012). Great American city: Chicago and the enduring neighborhood effect (1st ed.). Chicago: University of Chicago Press.
Sampson, R. J., Raudenbush, S. W., & Earls, F. (1997). Neighborhoods and violent crime: A multilevel study of collective efficacy. Science, 277(5328), 918–924.
Saunders, M. R., Lee, H., Maene, C., Schuble, T., & Cagney, K. A. (2014). Proximity does not equal access: Racial disparities in access to high quality dialysis facilities. Journal of Racial and Ethnic Health Disparities, 1(4), 291–299. https://doi.org/10.1007/s40615-014-0036-0.
Sewell, A. A. (2015). Disaggregating ethnoracial disparities in physician trust. Social Science Research, 54(November), 1–20. https://doi.org/10.1016/j.ssresearch.2015.06.020.
Shaw, R. J., & Pickett, K. E. (2011). The association between ethnic density and poor self-rated health among US black and Hispanic people. Ethnicity & Health, 16(3), 225–244. https://doi.org/10.1080/13557858.2011.561428.
Shoff, C., & Yang, T. C. (2012). Untangling the associations among distrust, race, and neighborhood social environment: A social disorganization perspective. Social Science & Medicine, 74(9), 1342–1352. https://doi.org/10.1016/j.socscimed.2012.01.012.
Small, M. L. (2009). Unanticipated gains: Origins of network inequality in everyday life. New York: Oxford University Press.
Stafford, M., Bécares, L., & Nazroo, J. (2010). Racial discrimination and health: Exploring the possible protective effects of ethnic density. In J. Stillwell & M. van Ham (Eds.), Ethnicity and integration, understanding population trends and processes (Vol. 3, pp. 225–250). Dordrecht: Springer.
Tian, N., Gaines Wilson, J., & Benjamin Zhan, F. (2010). Female breast cancer mortality clusters within racial groups in the United States. Health Place, 16(2), 209–218. https://doi.org/10.1016/j.healthplace.2009.09.012.
Torre, L. A., Bray, F., Siegel, R. L., Ferlay, J., Lortet-Tieulent, J., & Jemal, A. (2015). Global cancer statistics, 2012: Global cancer statistics, 2012. CA: A Cancer Journal for Clinicians, 65(2), 87–108. https://doi.org/10.3322/caac.21262.
U.S. Preventive Services Task Force. (2002). Final recommendation statement breast cancer: Screening. Rockville, MD: U.S. Preventative Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening-2002.
U.S. Preventive Services Task Force. (2016). Final recommendation statement breast cancer: Screening. Rockville, MD: U.S. Preventative Task Force. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening1.
Wang, F., McLafferty, S., Escamilla, V., & Luo, L. (2008). Late-stage breast cancer diagnosis and health care access in Illinois. The Professional Geographer, 60(1), 54–69. https://doi.org/10.1080/00330120701724087.
Watkins-Hayes, C. (2009). The New Welfare Bureaucrats: Entaglements of race, class, and policy reform. Chicago: University of Chicago Press.
Wellman, B., & Leighton, B. (1979). Networks, neighborhoods, and communities: Approaches to the study of the community question. Urban Affairs Review, 14(3), 363–390. https://doi.org/10.1177/107808747901400305.
Yang, T. C., Matthews, S. A., & Shoff, C. (2011). Individual health care system distrust and neighborhood social environment: How are they jointly associated with self-rated health? Journal of Urban Health, 88(October), 945–958. https://doi.org/10.1007/s11524-011-9561-x.
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Gibbons, J. Neighborhood Racial/Ethnic Composition and Medical Discrimination’s Relation to Mammograms: A Philadelphia Case Study. Race Soc Probl 13, 234–244 (2021). https://doi.org/10.1007/s12552-021-09312-9
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DOI: https://doi.org/10.1007/s12552-021-09312-9