A geographic information system (GIS)-based analysis of county-level economic and social vulnerabilities in FDA-certified mammogram facilities and breast cancer outcomes in Florida.

Abstract

e13736 Background: Breast cancer (BC) is a leading cause of cancer-related morbidity and mortality, with outcomes influenced by socioeconomic factors such as the Economic Hardship Index (EHI) and Social Vulnerability Index (SVI). Socioeconomic factors also impact access to mammogram facilities. This study examines the relationship and spatial distribution of FDA-certified mammogram facilities, cancer rates, EHI, and SVI in Florida to identify disparities impacting BC outcomes. Methods: BC age-adjusted incidence rates (AAIR, 2017-2021) and mortality rates (AAMR, 2018-2022) were sourced from the National Cancer Institute, EHI scores (2018-2022) from the Florida Department of Health, 2020 SVI rankings from the Centers for Disease Control and Prevention, and mammogram facility data from FDA-certified registries. Choropleth maps were created to visualize facility distributions with AAIR, AAMR, EHI, and SVI metrics. Regression and correlation analyses assessed relationships among these variables. Results: Higher SVI rankings were associated with increased AAMR (β = 3.80, p = 0.03) and decreased AAIR (β = -41.49, p < 0.001). Higher EHI was significantly linked to lower AAIR (β = -0.37, p < 0.001). The total number of mammogram facilities negatively correlated with AAMR (β = -0.06, p = 0.02). Strong positive correlations between EHI and SVI (r = 0.70, p < 0.0001) indicate that economically disadvantaged counties often face higher social vulnerability. EHI (r = -0.41, p < 0.001) and SVI (r = -0.41, p < 0.001) were negatively correlated with AAIR, suggesting that socioeconomic barriers may impede early cancer detection. SVI was positively correlated with AAMR (r = 0.30, p = 0.03), while the total number of facilities negatively correlated with AAMR (r = -0.32, p = 0.02). These trends, supported by spatial maps, highlight inequities in mammogram facility access in underserved areas facing socioeconomic challenges. Conclusions: The findings emphasize the urgent need to address socioeconomic and social vulnerabilities to reduce cancer disparities. Policy reforms are essential to improve access to mammogram facilities and early detection services, particularly in underserved areas, to mitigate systemic barriers disproportionately affecting vulnerable populations. Pearson correlation coefficients among socioeconomic, facility, and health outcome variables. EHI SVI Total Number of Facilities in a County Facility Density (facilities per 100,000 residents) Age-Adjusted Mortality Rate/100,000 Age-Adjusted Incidence Rate /100,000 EHI 1.00 SVI 0.69 1.00 Total Number of Facilities in a County -0.24 0.03 1.00 Facility Density (facilities per 100,000 residents) -0.08 -0.05 0.05 1.00 Age-Adjusted Mortality Rate/100,000 0.24 0.30 -0.32 0.11 1.00 Age-Adjusted Incidence Rate /100,000 -0.41 -0.41 0.20 -0.23 -0.40 1.00