low rates of cancer screening in rural kentucky
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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 Rat
o
Sigmoidoscopy & Colonoscopy Rates in KY 2002-2010, by Metro Status
2002 2004 2006 2008 201030
35
40
45
50
55
60
65
70
KY Metro KY Non-Metro KY
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 1 Metro vs Non-Metro in Model 1
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
Covariates in Model 1: Year, Metro Status; Covariates in Model 2: Year, AP Status
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
KY Metro KY Non-Metro KY
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 1 Metro vs Non-Metro in Model 1
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
Covariates in Model 1: Year, Metro Status; Covariates in Model 2: Year, AP Status
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
KY Metro KY Non-Metro KY
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 Rati
os
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 Rati
os
Correlation between Pap Screening and Demographic - Modeling Probability of having Pap screening within the past three yearsVariables Odds Ratio 95% CI p-valueYear 0.93 0.90 0.95 <0.0001Age 0.99 0.98 0.99 <0.0001Education
<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 <0.0001Education
<0.0001Reference = Less than HSHS or GED 1.8 1.6 2.1Education beyond HS 1.4 1.3 1.7
Income
<0.0001
Reference = less than $15,000$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 3.6Unknown 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 <.0001Age 1.02 1.02 1.03 <.0001Education
<.0001Reference = Less than HSHS or GED 1.42 1.21 1.67Education beyond HS 1.22 1.05 1.42
Income
0.003
Reference = less than $15,000$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 1.33Unknown 1.01 0.85 1.19
Metro Status (Metro vs Non Metro) 1.14 1.03 1.26 0.011
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