To model the relationship of an area‐based measure of a breast cancer screening and geographic area deprivation on the incidence of later stage breast cancer () across a diverse region of ppalachia.
Central cancer registry data (2006–2008) from three ppalachian states were linked to edicare claims and census data.
Exploratory spatial analysis preceded the statistical model based on negative binomial regression to model predictors and effect modification by geographic subregions.
Exploratory spatial analysis revealed geographically varying effects of area deprivation and screening on . In the negative binomial regression model, predictors of included receipt of screening, area deprivation, supply of mammography centers, and female population aged >75 years. The most deprived counties had a 3.31 times greater rate of compared to the least deprived. Effect of screening on was significantly stronger in northern Appalachia than elsewhere in the study region, found mostly for high‐population counties.
Breast cancer screening and area deprivation are strongly associated with disparity in in ppalachia. The presence of geographically varying predictors of later stage tumors in ppalachia suggests the importance of place‐based health care access and risk.