Farhad Islami

Association between racialized economic segregation and stage at diagnosis for 3 screenable cancers in New York City

Abstract Background Racial and economic segregation can create barriers to timely cancer diagnosis and adversely affect survival. This study examines the association between neighborhood-level segregation, measured by the neighborhood-Index of Concentration at Extremes (n-ICE), and stage at diagnosis (advanced [regional/distant] vs localized) for 3 screenable cancers in New York City. Methods We analyzed 98 449 incident cases (breast, 58 970; cervical, 4790; and colorectal, 34 689) using New York State Cancer Registry data (2008-2019). Census tract-level n-ICE measures of racial and/or income-based economic segregation were calculated. Age-adjusted stage-specific incidence rates and advanced-to-localized incidence rate ratios (IRRs) were measured across n-ICE quartiles. Results Advanced-to-localized stage IRRs were significantly higher in the most-deprived and/or non-Hispanic Black (NHB)-concentrated areas (Q1) than the most-affluent and/or most non-Hispanic White (NHW)-concentrated areas (Q4) for breast and cervical cancer (breast: n-ICEIncome, IRRQ1 = 0.71 vs IRRQ4 = 0.48; n-ICENHB, IRRQ1 = 0.75 vs IRRQ4 = 0.53; n-ICENHB+Income, IRRQ1 = 0.74 vs IRRQ4 = 0.47; cervical: n-ICEIncome, IRRQ1 = 1.30 vs IRRQ4 = 0.97; n-ICENHB, IRRQ1 = 1.44 vs IRRQ4 = 0.99; n-ICENHB+Income, IRRQ1 = 1.37 vs IRRQ4 = 0.92) (all P-values < .01). Hispanic concentration alone (n-ICEHispanic) was not associated with disparities; however, its combination with economic deprivation was significant in both cancers (breast: n-ICEHispanic+Income, IRRQ1 = 0.70 vs IRRQ4 = 0.47; cervical: n-ICEHispanic+Income, IRRQ1 = 1.31 vs IRRQ4 = 0.93) (all P-values < .01). All racialized-economic segregation measures (n-ICENHB+Income/n-ICEHispanic+Income) showed increasing IRRs with higher segregation for both cancers (all P-trend < .04). No disparities were observed for colorectal cancer. Conclusions Racialized-economic segregation in New York City was associated with higher advanced-stage diagnoses of breast and cervical cancer but not colorectal cancer. These findings may partially reflect both structural barriers that delay timely diagnosis and the impact of local equity-driven initiatives that broaden colorectal cancer screening access.

Association of mental health treatment receipt with cancer screening among US adults with a history of anxiety or depression

Adults with a history of depression or anxiety who lacked mental health treatment in the past year were significantly less likely to be up‐to‐date with breast, cervical, and colorectal cancer than those who received treatment. Concerted efforts to increase mental health treatment receipt among adults with mental illness may reduce disparities in cancer screening and related outcomes in this population.

Factors contributing to differences in cervical cancer screening in rural and urban community health centers

AbstractIntroductionCommunity health centers (CHCs) provide historically marginalized populations with primary care, including cancer screening. Previous studies have reported that women living in rural areas are less likely to be up to date with cervical cancer screening than women living in urban areas. However, little is known about rural–urban differences in cervical cancer screening in CHCs and the contributing factors, and whether such differences changed during the COVID‐19 pandemic.MethodsUsing 8‐year pooled Uniform Data System (2014‐2021) data and Oaxaca‐Blinder decomposition, the extent to which CHC‐ and catchment area–level characteristics explained rural‐urban differences in up‐to‐date cervical cancer screening was estimated.ResultsUp‐to‐date cervical cancer screening was lower in rural CHCs than urban CHCs (38.2% vs 43.0% during 2014–2019), and this difference increased during the pandemic (43.5% vs 49.0%). The rural–urban difference in cervical cancer screening in 2014–2019 was mostly explained by differences in CHC‐level proportions of patients with limited English proficiency (55.9%) or income below the poverty level (12.3%) and females aged 21 to 64 years (9.8%), and catchment area–level’s unemployment (3.4%) and primary care physician density (3.2%). However, Medicaid (–48.5%) or no insurance (–19.6%) counterbalanced the differences between rural–urban CHCs. The contribution of these factors to rural–urban differences in cervical cancer screening generally increased in 2020–2021.ConclusionsRural–urban differences in cervical cancer screening were mostly explained by multiple CHC‐level and catchment area–level characteristics. The findings call for tailored interventions, such as providing resources and language services, to improve cancer screening utilization among uninsured, Medicaid, and patients with limited English proficiency in rural CHCs.