@article{TCR29391,
author = {Mario Schootman and Kendra Ratnapradipa and Travis Loux and Allese McVay and L. Joseph Su and Erik Nelson and Susan Kadlubar},
title = {Individual- and county-level determinants of high breast cancer incidence rates},
journal = {Translational Cancer Research},
volume = {8},
number = {Suppl 4},
year = {2019},
keywords = {},
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.},
issn = {2219-6803}, url = {https://tcr.amegroups.org/article/view/29391}
}