Journal article
Spatial accessibility to colonoscopy and its role in predicting late-stage colorectal cancer
Health services research, v 56(1), pp 73-83
Feb 2021
PMID: 32954527
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Objective To better determine the relationship between spatial access to colonoscopy and colorectal cancer (CRC) outcomes, our objective was to examine the agreement of the classic, enhanced, and variable two-step floating catchment area (2SFCA) methods in evaluating spatial access to colonoscopy and to compare the predictive validity of each method related to late-stage CRC. 2SFCA methods simultaneously consider supply/demand of services and impedance (ie, travel time). Data Sources Colonoscopy provider locations were obtained from the South Carolina Ambulatory Surgery Database. ZIP code tabulation area (ZCTA) level population estimates and area-level poverty level were obtained from the American Community Survey. Rurality was determined by the United States Department of Agriculture's Rural-Urban Commuting Area codes. Individual-level CRC data were obtained from the South Carolina Central Cancer Registry. Study Design Using the classic, enhanced, and variable 2SFCA methods, we calculated ZCTA-level spatial access to colonoscopy. We assessed agreement between the three methods by calculating Spearman's rank coefficients and weighted Kappas (Kappa). Global and Local Moran'sIwere used to assess spatial clustering of accessibility scores across 2SFCA methods. We performed multilevel logistic regression analyses to examine the association between spatial accessibility to colonoscopy, area- and individual-level factors, and late-stage CRC. Principal Findings We found strong agreement (Weighted Kappa = 0.82; 95% CI = 0.79-0.86) and identified similar clustering patterns with the classic and enhanced 2SFCA methods. There was negligible agreement among the classic/enhanced 2SFCA and the variable 2SFCA. Across all 2SFCA methods, regression models showed that spatial access to colonoscopy, rurality, and poverty level were not associated with greater odds of late-stage CRC, though Black race was associated with late-stage CRC across all models. Conclusions None of the 2SFCA methods showed an association with late-stage CRC. Future studies should explore which elements (spatial or nonspatial) of access to care have the greatest impact on CRC outcomes.
Metrics
Details
- Title
- Spatial accessibility to colonoscopy and its role in predicting late-stage colorectal cancer
- Creators
- Whitney E. Zahnd - University of South CarolinaMichele J. Josey - University of South CarolinaMario Schootman - SSM Health CareJan M. Eberth - University of South Carolina
- Publication Details
- Health services research, v 56(1), pp 73-83
- Publisher
- Wiley
- Number of pages
- 11
- Grant note
- T32-GM081740 / National Institute of General Medical Sciences; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of General Medical Sciences (NIGMS) MRSG-15-148-01-CPHPS / American Cancer Society
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Health Management and Policy
- Web of Science ID
- WOS:000571071200001
- Scopus ID
- 2-s2.0-85091143034
- Other Identifier
- 991021855183104721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Health Care Sciences & Services
- Health Policy & Services