Laurie M DeChello

The geographic distribution of breast cancer incidence in Massachusetts 1988 to 1997, adjusted for covariates

BackgroundThe aims of this study were to determine whether observed geographic variations in breast cancer incidence are random or statistically significant, whether statistically significant excesses are temporary or time-persistent, and whether they can be explained by covariates such as socioeconomic status (SES) or urban/rural status?ResultsA purely spatial analysis found fourteen geographic areas that deviated significantly from randomness: ten with higher incidence rates than expected, four lower than expected. After covariate adjustment, three of the ten high areas remained statistically significant and one new high area emerged. The space-time analysis identified eleven geographic areas as statistically significant, seven high and four low. After covariate adjustment, four of the seven high areas remained statistically significant and a fifth high area also identified in the purely spatial analysis emerged.ConclusionsThese analyses identify geographic areas with invasive breast cancer incidence higher or lower than expected, the times of their excess, and whether or not their status is affected when the model is adjusted for risk factors. These surveillance findings can be a sound starting point for the epidemiologist and has the potential of monitoring time trends for cancer control activities.

A space-time analysis of the proportion of late stage breast cancer in Massachusetts, 1988 to 1997

BackgroundEarly detection is the best way to control breast cancer. This observational epidemiologic study uses ten years of data, 1988–1997, to determine whether the observed variations in the proportion of breast cancers diagnosed at late stage are simply random or are statistically significant with respect to both geographical location and time.ResultsA total of three spatial-temporal areas were found to deviate significantly from randomness in the unadjusted analysis; one of the three areas contained statistically significant excesses in proportion of late stage, while two areas were identified as significantly lower than expected. The area of excess spanned the first three years of the study period, while the low areas spanned the last five years of the study period. Some of these areas were no longer statistically significant when adjustments were made for SES and urban/rural status.ConclusionAlthough there was an area of excess in eastern Massachusetts, it only spanned the first three years of the study period. The low areas were fairly consistent, spanning the last five years of the study period.

Spatial analysis of colorectal cancer incidence and proportion of late-stage in Massachusetts residents: 1995–1998

BackgroundThe aims of this study were to determine if observed geographic variations in colorectal cancer incidence are simply random or are statistically significant deviations from randomness, whether statistically significant excesses are temporary or persistent, and whether they can be explained by risk factors such as socioeconomic status (SES) or the percent of the population residing in an urban area rather than a rural area. Between 1995 and 1998, 6360 male and 6628 female invasive colorectal cancer cases were diagnosed in Massachusetts residents. Cases were aggregated to Census tracts and analyzed for deviations from random occurrence with respect to both location and time.ResultsSix geographic areas that deviated significantly from randomness were uncovered in the age-adjusted analyses of males: three with higher incidence rates than expected and eight lower than expected. In the age-adjusted analyses of females, one area with a higher incidence rate, and one area with a lower incidence rate than expected, were found. After adjustment for SES and percent urban, some of these areas were no longer significantly different.ConclusionPublic health practitioners can use the results of this study to focus their attention onto areas in Massachusetts that need to increase colorectal screening or have elevated risk of colorectal cancer incidence.

Effects of study area size on geographic characterizations of health events: Prostate cancer incidence in Southern New England, USA, 1994–1998

BackgroundWe consider how representations of geographic variation in prostate cancer incidence across Southern New England, USA may be affected by selection of study area and/or properties of the statistical analysis.MethodA spatial scan statistic was used to monitor geographic variation among 35,167 incident prostate cancer cases diagnosed in Massachusetts, Connecticut and Rhode Island from 1994 to 1998, in relation to the 1990 populations of men 20+ years of age living in that region. Results from the combined-states analysis were compared to those from single-states. Impact of scanning procedures set to examine up to 50% or no more than10% of at-risk populations also was evaluated.ResultsWith scanning set to 50%, 5 locations in the combined-states analysis were identified with markedly distinct incidence rates. Fewer than expected cases were estimated for nearly all Connecticut, Rhode Island and West Central Massachusetts, whereas census tracts on and around Cape Cod, and areas of Southwestern Connecticut and adjacent to greater Boston were estimated to have yielded more than expected incidence. Results of single-state analyses exhibited several discrepancies from the combined-states analysis. More conservative scanning found many more locations with varying incidence, but discrepancies between the combined- and single-state analysis were fewer.ConclusionIt is important to acknowledge the conditional nature of spatial analyses and carefully consider whether a true cluster of events is identified or artifact stemming from selection of study area size and/or scanning properties.

Race-specific geography of prostate cancer incidence

BackgroundThis study evaluated geographic distribution of race-specific prostate cancer incidence in Connecticut and Massachusetts. This cross-sectional analysis of census and cancer registry data included records of 29,040 Whites and 1,647 African Americans diagnosed with incident prostate cancer between 1994 and 1998. A spatial scan statistic was used to detect and test significance of the geographic variation in race-specific incidence rates within the two-state area.ResultsSignificant geographic variation in age-adjusted incidence rates among both White and African American men was observed, with little overlap noted between distributions. Identified locations reflected patterns of residential segregation and socio-economic conditions. Among Whites, places with higher than expected incidence had higher socioeconomic status than places with lower than expected incidence. No discernable relationship between social indicators and rate variation among African Americans was evident.ConclusionDifferences in race-specific geographic distribution of prostate cancer incidence do not suggest a shared environmental etiology. Furtherstudyof genetic, behavioral and health carefactors affecting the occurrence and/or reporting of the disease is warranted. This study highlights the need for race- and geographic-specific interventions to better control disease within at-risk communities and for on-going analysis into social and contextual factors that contribute to observed disparities between African Americans and Whites in the occurrence of cancer.

The geographic distribution of melanoma incidence in Massachusetts, adjusted for covariates

BackgroundThe aims of this study were to determine whether observed geographic variations in melanoma cancer incidence in both gender groups are simply random or are statistically significant, whether statistically significant excesses are temporary or persistent, and whether they can be explained by risk factors such as socioeconomic status (SES) or the percent of the population residing in an urban rather than a rural area. Between 1990 and 1999, 4774 female and 5688 male melanomas were diagnosed in Massachusetts residents. Cases were aggregated to census tracts and analyzed for deviations from random occurrence with respect to both spatial location and time.ResultsThirteen geographic areas that deviated significantly from randomness were uncovered in the age-adjusted analyses of males: five with higher incidence rates than expected and eight lower than expected. In the age-adjusted analyses of females, six areas with higher incidence rates and eight areas with lower than expected incidence rates were found. After adjustment for SES and percent urban, several of these areas were no longer significantly different.ConclusionThese analyses identify geographic areas with invasive melanoma incidence higher or lower than expected, the times of their excess, and whether or not their status is affected when the model is adjusted for risk factors. These surveillance findings can be a sound starting point for the shoe-leather epidemiologist.

Service Learning Within the University of Connecticut Master of Public Health Program

Since 2005, the University of Connecticut Master of Public Health Program has administered its required service-learning practicum through coordinated activities of second-year students assigned to examine a pressing public health issue in Connecticut. The initiative underscores our programs commitment to preparing students for careers as leaders in applied practice and our emphasis on collaboration. Our thematic approach links content across the core curriculum, provides a venue where students demonstrate mastery of academic principles, and affirms values of public responsibility and common purpose. Projects have focused on public health concerns associated with childhood obesity, health literacy, and living with disabilities. Working together and with community-based preceptors, students estimate service needs, assess available program/service capacity, and recommend policy options. Results are compiled within a written report that accompanies a state legislative hearing. This article presents the rationale and organization of our service-learning practicum, and describes how the experience affects the education and personal growth of students and contributes positively to the community at large.