Receipt of Regular Primary Care and Early Cancer Detection in Appalachia
Bibliographic Data
| ID | 19432259 |
|---|---|
| Authors | Fabian Camacho (0000-0002-4878-0283, Department of Public Health Science College of Medicine The Pennsylvania State University Hershey Pennsylvania, corresponding author), Wenke Hwang (0000-0002-8116-807X, Department of Public Health Science College of Medicine The Pennsylvania State University Hershey Pennsylvania), Teresa Kern (Department of Public Health Science College of Medicine The Pennsylvania State University Hershey Pennsylvania), Roger T Anderson (0000-0001-8112-4117, Department of Public Health Science College of Medicine The Pennsylvania State University Hershey Pennsylvania) |
| Year | 2015 |
| Volume | 31 |
| Issue | 3 |
| Pages | 269-281 |
| Publication date | 2015-07-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | The Journal of Rural Health (JOURNAL) |
| Journal identifiers | ISSN: 0890-765X • E-ISSN: 1748-0361 |
| Publisher | Wiley (PUBLISHER • GB) |
| DOI | 10.1111/jrh.12097 |
| PMID | 25370354 |
| OpenAlex | W1568460854 |
| Language | EN |
| Citations received | 2 |
| References cited | 32 |
PURPOSE: The objective was to examine the impact of regular primary care encounters (PCE) on early breast cancer detection in an Appalachian sample of Medicare beneficiaries diagnosed 2006-2008. Determinants of PCE were investigated and a mediation analysis was conducted where PCE was a mediator to cancer stage. METHODS: A total of 3,589 cases were identified from Appalachian areas in Pennsylvania, Kentucky, Ohio, and North Carolina, and health care services were examined 2 months to 2 years prior to diagnosis. A regular care PCE variable was constructed with 4 ordinal levels: none, any, "annual," and "semi-annual." Association of PCE with stage, mortality and covariables was conducted using ordinal logistic regressions and Cox Proportional Hazards survival models. RESULTS: Sixty-eight percent of the cases had semi-annual PCE. Regular PCE was strongly associated with late-stage cancer rates (39%-13% by increasing PCE level, P < .0001) and 5-year all-cause mortality (42%-24%, P < .0001). Subgroup analysis revealed variations by hypertension and urban status, with nonhypertensives with no PCE being at particularly increased risk. Significant determinants of PCE included age, rural/urban status, comorbidity, dual Medicaid insurance, Appalachian region economic classification, state, select comorbidities, hypertension, and minimum distance to provider. Mediation analysis results were consistent with lower number of comorbidities leading to increased late cancer detection due to patients having a decreased PCE. CONCLUSION: PCE is an important determinant of cancer detection, with a dose-response relationship. Variations exist by geography and hypertension. Comorbidity may influence both PCE and late-stage rates with partial mediation through PCE
Cancer · Comorbidity · Health care · Logistic regression · Medicaid · Proportional hazards model · Demography · Digital Radiography and Breast Imaging · Global Cancer Incidence and Screening · Medicine · Primary Care and Health Outcomes · Gerontology · Internal Medicine
Primary Care
Odds Ratios for Mediation Analysis for a Dichotomous Outcome
Equivalence of the Mediation, Confounding and Suppression Effect
Contribution of Primary Care to Health Systems and Health
Generalized Ordered Logit/Partial Proportional Odds Models for Ordinal Dependent Variables
Barriers to Cancer Screening by Rural Appalachian Primary Care Providers
Cancer Incidence in Kentucky, Pennsylvania, and West Virginia
Metropolitan, Urban, and Rural Commuting Areas
Developing a Claim-based Version of the ACE-27 Comorbidity Index
The moderator–mediator variable distinction in social psychological research
The moderator-mediator variable distinction in social psychological research
| Citations per year | 0.18 |
|---|---|
| Citation span | 2015 - 2023 (9) |
| Highly cited | No |