Abstract 4211: Geospatial analyses identify hot spots of late-stage cervical cancer at diagnosis in Texas
Authors: Sokale Itunu O. , Thrift Aaron P. , Oluyomi Abiodun O. 
Published: April 2023

Abstract
Background: Women with advanced cervical cancer at diagnosis have higher morbidity and mortality. Despite advancements in prevention and early detection, cervical cancer care disparities persist by race/ethnicity and geographical distribution. We aimed to identify spatial clusters of late-stage cervical cancer at diagnosis in Texas, a state with a higher than national cervical cancer rate, especially among racial/ethnic minority populations.Methods: Incident cervical cancer data were obtained from the Texas Cancer Registry for women aged 18 years or older diagnosed from 2000 to 2018. First, we conducted purely spatial scan analysis using the SaTScan Bernoulli model to identify geographic clusters (hot spots and cold spots) of late-stage cervical cancer (vs. early-stage) at diagnosis. Maximum cluster size was set at 50% of the at-risk population, and statistical significance at p &lt;0.005 was explored by 999 Monte Carlo simulations. Finally, we used multivariable logistic regression models to investigate the characteristics of cases within each of the identified clusters.Results: SaTScan identified six clusters, three with significantly lower than expected number of late-stage cervical cancer cases (cold spots) and three with significantly higher than expected number of late-stage cervical cancers cases at diagnosis (hot spots). Hot spots were found around Public Health Regions 5/6 (Houston, a large metropolitan city with the highest rate of uninsured residents in Texas), Region 10 (El Paso, a border region) and Region 8 (San Antonio, the largest majority Hispanic population region). Compared to White women, Black women were less likely to be in cold spots (Cluster 1: odds ratio (OR) 0.44 (95% CI 0.33-0.57), Cluster 2: OR 0.42 (95% CI 0.28-0.64)), but more likely to be in hot spots (Cluster 3 OR 1.33 (1.15-1.54). Similarly, Hispanic women had greater odds of being in hot spots (Cluster 4: OR 5.26 (95% CI 4.15-6.68), Cluster 5: OR 12.43 (95% CI 8.82-17.52)) than non-Hispanic women. Likewise, compared to women living in census tracts with lower neighborhood-level poverty, those women living in census tracts with higher deprivation were more likely to be in the hot spots (Cluster 3: OR 1.28 (95% CI 1.10-1.49), Cluster 4: OR 55.07 (95% CI 17.63-172.00), Cluster 5: OR 8.24 (95% CI 4.87-13.95)). Conclusions: Considerable inequalities exist in late-stage cervical cancer diagnosis in Texas, in terms of place, race/ethnicity, and neighborhood disadvantages. Strategic and multicomponent population-based interventions are needed to address cancer care inequities.Impact: The study findings could be incorporated into designing effective multilevel interventions, including place-based and race-targeted strategies to improve cervical cancer outcomes.
Citation Format: Itunu O. Sokale, Aaron P. Thrift, Abiodun O. Oluyomi. Geospatial analyses identify hot spots of late-stage cervical cancer at diagnosis in Texas. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4211.