Document Type
Article
Journal Title
Translational Cancer Research
Publication Date
2019
Volume
8
Abstract
Background: Age-adjusted breast cancer rates vary across and within states. However, most statistical models inherently identify either individual- or area-level determinants to explain geographic disparities in breast cancer rates and ignore the effects of the other level of determinants. We present a micro-macro modelling approach that incorporates both levels of determinants to better explain this variability and to discover opportunities to reduce breast cancer rates.
Methods: Individual-level data about breast cancer risk factors from eligible Arkansas Rural Community Health (ARCH) study participants (n=13,554) was supplemented with publicly available county-level data using a novel micro-macro statistical approach. This model uses individual-level data to account for aggregation-induced biases, to predict county-level breast cancer incidence rates across Arkansas.
Results: County-level breast cancer incidence rates ranged from 80.9 to 161.6 per 100,000 population. The best-fit model, which included individual-level predicted risk based on the Gail/CARE models, county-level population density (log transformed), and lead exposure (log transformed), explained 14.1% of the county variance.
Conclusions: Our results support theoretical models that maintain that area-level determinants of breast cancer incidence are key risk factors in addition to established individual risks.
DOI Link
ISSN
2219-6803
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Recommended Citation
Schootman, Mario; Ratnapradipa, Kendra; Loux, Travis; McVay, Allese; Su, L. Joseph; Nelson, Erik; and Kadlubar, Susan, "Individual- and County-Level Determinants of High Breast Cancer Incidence Rates" (2019). Journal Articles: Epidemiology. 148.
https://digitalcommons.unmc.edu/coph_epidem_articles/148