Breast and cervical cancer mortality in the Mississippi Delta, 1979-1998.Background: Historically, the Mississippi Delta This article is about the geographic region of the U.S. state of Mississippi. For other uses, see Mississippi Delta (disambiguation).
The Mississippi Delta is the distinct northwest section of the state of Mississippi that lies between the Mississippi and Yazoo region has been medically underserved. This may lead to lower cancer prevention efforts and higher breast or cervical cancer Cervical Cancer Definition
Cervical cancer is a disease in which the cells of the cervix become abnormal and start to grow uncontrollably, forming tumors. mortality rates.
Methods: Death rates for 1979 through 1998 were calculated for Mississippi Delta women and for women living elsewhere in the US.
Results: Breast cancer mortality in the Delta was similar to that elsewhere in the US in recent years for both black and white women, but rates were lower in the Delta in the early years of the study period. Overall, cervical cancer mortality was similar in the two areas but rates declined more rapidly elsewhere in the US than in the Delta. Breast and cervical cancer mortality was higher among black women than among white women in both areas. Cervical cancer mortality was higher among white rural and black urban women in the Delta than their counterparts elsewhere.
Conclusion: These results can guide prevention activities for reducing mortality from these diseases.
Key Words: breast cancer, cervical cancer, mortality
Historically, residents of the Mississippi Delta have suffered from high rates of unemployment and poverty, substantial deficits in education, poor nutrition, and inadequate access to health care. Conditions for rural, elderly, and black residents of the Delta are of particular concern. (1) These factors may lead to underuse underuse Health care The failure to provide a medical intervention when it is likely to produce a favorable outcome for a Pt–eg, failure to give influenza vaccine to an elderly Pt with DM. Cf Misuse, Overuse. of cancer screening, in turn leading to a higher incidence of late-stage disease and higher death rates. Unfortunately, little has been published about cancer rates among women in the Mississippi Delta. Studies providing information on small areas within the Delta, however, suggest that the incidence of breast cancer may be lower in the region than nationally, but that cervical cancer may be more common. (2-5) In addition, screening rates for these cancers may be lower in the Delta than in the US as a whole. (6)
The US Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979
Health and Human Services, HHS (7) sets nationwide targets for breast and cervical cancer mortality. In addition, it has set forth a primary goal of eliminating health disparities
Health disparities (also called health inequalities in some countries) refer to gaps in the quality of health and health care across racial, ethnic, and socioeconomic groups. . Race, ethnicity ethnicity Vox populi Racial status–ie, African American, Asian, Caucasian, Hispanic , lower education or income, lack of access to health care or health insurance, and rural location have all been associated with less use of preventive preventive /pre·ven·tive/ (pre-vent´iv) prophylactic.
pre·ven·tive or pre·ven·ta·tive
Preventing or slowing the course of an illness or disease; prophylactic.
n. screening. (7-9) The quality of screening with mammography mammography, diagnostic procedure that uses low-dose X rays to detect abnormalities in the breasts. The early diagnosis of breast cancer made possible by the routine use of mammography for screening women increases a woman's treatment alternatives and improves her and Papanicolaou (Pap) tests is variable; (10,11) where they are substandard substandard,
adj below an acceptable level of performance. , screening may be less effective. These factors, in turn, may lead to detection of cancers at a later stage, leading to poorer survival and higher mortality. (9,12,13)
This study examined trends in death rates from breast and cervical cancer in the Mississippi Delta from 1979 through 1998 for black and white women. Death rates for the Delta were compared with those of the remainder of the US. In addition, rates were examined by age and by rural and socioeconomic so·ci·o·ec·o·nom·ic
Of or involving both social and economic factors.
of or involving economic and social factors
Adj. 1. indicators for the county of residence.
In 1988, Congress enacted Public Law 100-460, which established the Lower Mississippi Delta Development Commission to assess the needs, problems, and opportunities of people living in the Lower Delta, a region of 219 counties or parishes (Louisiana Louisiana (ləwē'zēăn`ə, lē'–), state in the S central United States. It is bounded by Mississippi, with the Mississippi R. ) within Arkansas Arkansas, river, United States
Arkansas (ärkăn`zəs, är`kənsô'), river, c.1,450 mi (2,330 km) long, rising in the Rocky Mts., central Colo. , Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee. The Consolidated Appropriations Act of 2001 (Public Law 106-554) added 16 Alabama counties to the region, bringing the total to 235. The Delta (Fig. 1) is made up of 16 counties in Alabama The U.S. state of Alabama is comprised of sixty-seven counties. The oldest and newest counties in Alabama are Washington County (created June 4, 1800) and Houston County (created February 9, 1903), respectively. , 42 in Arkansas, 16 in Illinois, 21 in Kentucky, 45 (parishes) in Louisiana, 45 in Mississippi, 29 in Missouri, and 21 in Tennessee.
Breast and cervical cancer death rates were calculated using information on death certificates sent by the states to the National Center for Health Statistics National Center for Health Statistics (NCHS) is part of the Centers for Disease Control and Prevention (CDC), which is part of the United States Department of Health and Human Services.
NCHS is the United States' principal health statistics agency. (NCHS NCHS National Center for Health Statistics
NCHS Naperville Central High School (Illinois)
NCHS North Central High School
NCHS Natrona County High School (Wyoming)
NCHS National Center for Health Services ) of the Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. (CDC See Control Data, century date change and Back Orifice.
CDC - Control Data Corporation ), where it was processed and consolidated. (14) The underlying cause of death of the deceased deceased 1) adj. dead. 2) n. the person who has died, as used in the handling of his/her estate, probate of will and other proceedings after death, or in reference to the victim of a homicide (as: "The deceased had been shot three times. along with age, race, sex, and county of residence were provided to NCHS. Selection of breast or cervical cancer as the underlying cause of death followed procedures specified by the World Health Organization in the 9th Revision of the Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. (15) All female breast and cervical cancer deaths reported for 1979 through 1998 for the Mississippi Delta were included in the analysis.
Denominators for the rate calculations were obtained from estimates made by the US Bureau of the Census Noun 1. Bureau of the Census - the bureau of the Commerce Department responsible for taking the census; provides demographic information and analyses about the population of the United States
Census Bureau and provided to the National Cancer Institute. (16) Estimates of the populations of US counties were available for 5-year age groups, sex, and race for each year studied. Rates were directly standardized standardized
pertaining to data that have been submitted to standardization procedures.
standardized morbidity rate
see morbidity rate.
standardized mortality rate
see mortality rate. to the age distribution of the 1970 US standard million population (adjustment was by 5-year groups).
[FIGURE 1 OMITTED]
Annual age-adjusted death rates from 1979 to 1998 were calculated for the entire Mississippi Delta and for other US women. Analyses were conducted on all women and on white (68.3% of Delta female population) and black women (30.8%) separately, but not on other racial or ethnic groups, which were few in number (0.8%). During the study period, breast cancer deaths totaled 19,481 among white women and 7,539 among black women. Cervical cancer deaths were 2,244 and 2,074, respectively. Women of other racial groups had fewer than 70 breast or cervical cancer deaths. Rates were also calculated for age groups (<50, 50-69, and [greater than or equal to]70 yr). This study was exempt from institutional review board review.
We used join point regression regression, in psychology: see defense mechanism.
In statistics, a process for determining a line or curve that best represents the general trend of a data set. techniques to characterize the trends in death rates. (17) The analyses determined the calendar years (joinpoints) when a change in trends occurred; we tested for model fit with a maximum of 4 joinpoints in the model. For each line segment identified, we calculated the estimated annual percent change (EAPC EAPC Euro-Atlantic Partnership Council
EAPC European Association for Palliative Care
EAPC Early American Prescut
EAPC East African Petroleum Conference
EAPC External Affairs Policy Coordination (Sprint) ) and 95% confidence interval confidence interval,
n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. (CI).
We also calculated average annual age-adjusted death rates for the combined 5-year period 1994 through 1998 for the Delta and non-Delta areas within the 8 states in the study; calculating 5-year rates improved the stability of the estimates. To compare death rates between these regions, the percentage difference, standard error, and z-statistic were calculated. (18)
In addition, average annual age-adjusted death rates for 1994 through 1998 were assessed by county economic levels and degree of rurality as compared within the Mississippi Delta and with the remainder of the US. Counties were defined as economically distressed if they had a three-year (1997-1999) average unemployment rate that was at least 1.5 times (150%) the US average of 4.6%; had a per-capita income that was less than two thirds (67%) of the US average of $23,564; and had a poverty rate that was at least 1.5 times (150%) of the US average of 13.1% or had 2 times (200%) the poverty rate. (19) Distressed counties were compared with all other counties. Counties were classified in three levels of rurality. Urban counties included (I) central and (II) fringe Fringe (optics)
One of the light or dark bands produced by interference or diffraction of light. Distances between fringes are usually very small, because of the short wavelength of light. counties of metro areas This article is about the music production team. For the article about population centers, see metropolitan area.
Metro Area are a Brooklyn-based dance music production team composed of Morgan Geist and Darshan Jesrani. of 1 million population or more, (III) counties in metropolitan areas of 250,000 to 1 million population, and (IV) counties in metro areas of fewer than 250,000 population (Subcategories I-IV correspond to Codes 0-3 of rural-urban continuum Continuum (pl. -tinua or -tinuums) can refer to:
At the beginning of the 20-year study period (1979), breast cancer death rates (per 100,000 women) for both white (21.3) and black (22.6) women were lower in the Mississippi Delta than elsewhere in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. (26.4 and 26.0, respectively) (Fig. 2). Death rates among white women elsewhere in the United States decreased during the latter half of the study period to a rate (22.3 in 1998) similar to that of their Mississippi Delta counterparts (21.4). Among black women, breast cancer death rates increased in both areas early on but leveled off and were similar in the latter part of the study period (in 1998 they were 29.4 in the Mississippi Delta and 29.6 elsewhere). Breast cancer death rates were higher among black than among white women in both areas during the later years of the study period.
Age-specific breast cancer death rates were, for the most part, lower in the Delta than elsewhere in the United States (Table 1). In the 1990s, however, rates were relatively higher among Delta women aged less than 50 years, but since 1995 rates among these younger Delta women have decreased (EAPC -6.8). For women aged 50 to 69 years, other US women (EAPC -2.8 for 1990-1995 and -4.4 for 1995-1998) had a greater decrease than their Delta counterparts (EAPC -1.5 for 1990-1998).
[FIGURE 2 OMITTED]
For 1994 through 1998, the average annual age-adjusted breast cancer death rates in the Mississippi Delta area of each of the 8 study states ranged from 21.9 to 26.6 per 100,000 women (Table 2). Significantly elevated rates in the Delta area (versus the remainder of the state) were found in Arkansas and Tennessee; in Illinois, the rate of the Delta area was significantly lower.
Breast cancer death rates in economically distressed counties did not differ between the Mississippi Delta and the remainder of the United States (Table 3). In nondistressed counties, black women in the Delta had a higher death rate than other black women in the United States, but white women in the Delta had a lower death rate than white women elsewhere. Urban white women had a lower death rate in the Delta than white women elsewhere in the United States. Urban black women in both the Delta and elsewhere in the United States had higher death rates than rural black women.
Cervical cancer death rates (per 100,000 women) were similar for white women in the Mississippi Delta to those for white women elsewhere in the US throughout the study period (3.3 in 1979 for both regions; 2.7 in the Delta and 2.2 elsewhere in the United States in 1998) (Fig. 3). Black women in both regions had higher cervical cancer death rates than white women throughout the study period. Although death rates were similar for black women in the two regions at the beginning of the study period (8.7 Delta; 8.9 other US), death rates decreased faster for black women elsewhere in the United States (EAPC -2.9), reaching 4.8 in 1998, than for black women in the Delta (EAPC -2.0), who had a rate of 6.2 in 1998. During the study period, larger decreases were observed for women aged 50 to 69 years and 70 years or more in the remainder of the United States than in the Mississippi Delta (Table 4).
The average annual age-adjusted cervical cancer death rates for 1994 through 1998 in the Mississippi Delta area of each state ranged from 2.6 to 4.4 per 100,000 women (Table 2). Rates were significantly higher in the Delta areas of Alabama, Illinois, Mississippi, Missouri and Tennessee than elsewhere in those states.
The cervical cancer death rate among black women who resided in economically nondistressed counties in the Delta was higher than the death rate for their counterparts elsewhere in the United States (Table 3). Among white women, death rates were higher for women from distressed counties than for women from nondistressed counties in both the Delta and the rest of the United States
[FIGURE 3 OMITTED]
Among whites, suburban and rural women in the Delta had higher death rates than their counterparts in the remainder of the United States (Table 3). Similar to the findings for economically nondistressed counties, urban black women in the Delta had a higher death rate than urban black women elsewhere in the United States Among white women in both regions, rural residents had higher death rates than urban women.
In this study we found that for both black and white women, breast cancer death rates for Mississippi Delta residents were lower than the rates for women elsewhere in the United States in 1979, but that race-specific rates are now similar for the two regions. Black women have been faring relatively poorly, however, as in both regions their rates have been markedly higher than those of white women in recent years. In the Delta, rates for black women increased substantially until 1991, then declined nonsignificantly. Among black women, residents of counties that were not economically distressed had a higher death rate than their counterparts elsewhere in the United States. Within the Delta, urban black women had higher death rates than their rural counterparts.
The lower death rates from breast cancer among women of the Mississippi Delta at the beginning of the study period may have been preceded by a lower incidence of breast cancer. Incidence rates lower than national and state levels have been found for some parts of the Mississippi Delta in Louisiana for both white and black women. (2,3,5) The regional differences in incidence may be due to differences in risk factors, such as age at first live birth, age at menarche menarche /me·nar·che/ (me-nahr´ke) establishment or beginning of the menstrual function.menar´cheal
The first menstrual period, usually during puberty. , and age at menopause menopause (mĕn`əpôz) or climacteric (klīmăk`tərĭk, klī'măktĕr`ĭk) . (21) Relatively low screening rates in the region may also play a role, as incidence rates would rise after screening is introduced into a population. A higher cancer death rate for black women than white women has been documented in Louisiana. (22)
The rapid rise in death rates for breast cancer among black women during the early years of the study period may be related to increasing incidence rates in conjunction with a lack of screening and access to state-of-the-art treatment. A study from Mississippi (23) revealed that urban black women have a higher incidence of breast cancer and a higher death rate (similar to our findings) than rural black women, possibly due to less access to or use of screening services or to inadequate treatment. In addition, women may move from rural to urban areas to obtain treatment or social or financial support. Nevertheless, screening rates in the 1990s, based on national population surveys, have generally been high for both black and white women. (24-26) Future studies are needed to determine whether there are any differences in screening between black and white women in the Mississippi Delta versus the remainder of the United States. In one small study from rural Mississippi, for example, the number of screening-detected breast cancers was lower than expected for white women and even lower for black women. (6) Screening may be particularly low among black women in areas of the Delta that are not economically distressed. This seemingly seem·ing
Outward appearance; semblance.
seeming·ly adv. contradictory situation may be due to the fact that an urban area may not be economically distressed but can nonetheless include a population of urban poor who may lack health insurance and have less access to or use of screening services.
Death rates from cervical cancer for both black and white women decreased more rapidly during the study period in the remainder of the United States than in the Mississippi Delta. The groups less than 50 years of age in both regions, however, did not experience significant declines in deaths over the study period. In recent years black women of the Mississippi Delta have experienced higher death rates than black women elsewhere in the United States. We also found that for white women, both suburban and rural women in the Delta had higher death rates than their counterparts elsewhere in the United States. For black women, we found higher rates among urban Delta residents.
Cervical cancer incidence rates (1983-1986) in areas of Louisiana CODE, OF LOUISIANA. In 1822, Peter Derbigny, Edward Livingston, and Moreau Lislet, were selected by the legislature to revise and amend the civil code, and to add to it such laws still in force as were not included therein. that are part of the Delta were comparable to Surveillance, Epidemiology epidemiology, field of medicine concerned with the study of epidemics, outbreaks of disease that affect large numbers of people. Epidemiologists, using sophisticated statistical analyses, field investigations, and complex laboratory techniques, investigate the cause , and End Results (SEER) incidence rates for white women but higher than SEER rates for black women. (2) In the industrial corridor in Louisiana, extending south from Baton Rouge Baton Rouge (băt`ən rzh) [Fr.,=red stick], city (1990 pop. 219,531), state capital and seat of East Baton Rouge parish, SE La. but not including New Orleans New Orleans (ôr`lēənz –lənz, ôrlēnz`), city (2006 pop. 187,525), coextensive with Orleans parish, SE La., between the Mississippi River and Lake Pontchartrain, 107 mi (172 km) by water from the river mouth; founded , Chen et al (4) found a significantly lower incidence of cervical cancer for white women than in SEER or the state of Louisiana as a whole (not significant) for 1989 to 1993. Among black women, incidence rates were higher than SEER rates but lower than the state rate, but these findings were not statistically significant. Higher cervical cancer death rates among Louisiana black women than in their white counterparts have also been reported. (22)
Our finding that white women in suburban and rural Delta counties Delta County is the name of several counties in the United States:
Among Mississippi Delta black women, we found that cervical cancer death rates were higher for those living in nondistressed or urban counties than for their counterparts elsewhere in the US. Lower screening rates in these areas may be related to poverty, education, lack of health insurance, or other barriers (7-9,30) rather than availability of screening facilities. In general, poverty or social class, as measured by occupation, income, or education, has been associated with increased risk of death. (31,32) We also found that death rates among older women declined at a slower pace in the Mississippi Delta than in the remainder of the United States, which may indicate that these women receive less screening or have less access to state-of-the-art treatment for invasive invasive /in·va·sive/ (-siv)
1. having the quality of invasiveness.
2. involving puncture of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. cancer. If all women could adhere to adhere to
verb 1. follow, keep, maintain, respect, observe, be true, fulfil, obey, heed, keep to, abide by, be loyal, mind, be constant, be faithful
2. guidelines guidelines,
n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. for cervical cancer screening and receive appropriate follow-up and treatment for precancerous precancerous /pre·can·cer·ous/ (-kan´ser-us) pertaining to a pathologic process that tends to become malignant.
adj. and cancerous lesions, almost all deaths from cervical cancer could be prevented.
Previous authors have noted that differences in socioeconomic status socioeconomic status,
n the position of an individual on a socio-economic scale that measures such factors as education, income, type of occupation, place of residence, and in some populations, ethnicity and religion. account for much of the disproportionately dis·pro·por·tion·ate
Out of proportion, as in size, shape, or amount.
dispro·por higher rate in cancer mortality among black women compared to white women, and that cancer survival is lower among the poor. Low socioeconomic status, regardless of race, is associated with lack of adherence adherence /ad·her·ence/ (ad-her´ens) the act or condition of sticking to something.
immune adherence to cancer screening guidelines cancer screening guideline Any guideline promulgated by an authoritative organization–eg Am Cancer Society, for early detection of a malignancy common in a particular population, the diagnosis of which, if caught early, results in a complete cure or improved . Factors such as low income or educational level, substandard living conditions living conditions npl → condiciones fpl de vida
living conditions npl → conditions fpl de vie
living conditions living , inadequate social support, unemployment, poor nutrition, and diminished di·min·ish
v. di·min·ished, di·min·ish·ing, di·min·ish·es
a. To make smaller or less or to cause to appear so.
b. access to health care may contribute, regardless of race, to decreased cancer survival. (33) Socioeconomically disadvantaged This article or section may contain original research or unverified claims.
Please help Wikipedia by adding references. See the for details.
This article has been tagged since September 2007. persons are more likely to be uninsured or underinsured un·der·in·sure
tr.v. un·der·in·sured, un·der·in·sur·ing, un·der·in·sures
To insure under a policy that provides inadequate benefits: Be certain that you are not underinsured against catastrophic illness. , and they often experience delays in diagnosis and treatment or suboptimal Suboptimal
A solution is called suboptimal if a part of the solution has been optimized without regards to the overall objective. treatment once a diagnosis of cancer has been made. (34) The percentage of population with income below the federal poverty level ranged from 13% (Missouri) to 22% (Louisiana and Mississippi) in 2000 in states which have a part of their territory in the Delta region. (35) All but two states had a higher proportion of their population living with incomes below the poverty level than the US average of 16%. All Delta states Delta State is a state in Nigeria, named for the Niger Delta. The state borders Edo State, Ondo State , Imo State, Anambra State and Bayelsa State. In the south west and south it has approximately 122 kilometres of coastline bounded by the Bight of Benin on the Atlantic ocean. except Illinois had a higher percentage of their population depending on Medicaid than the national average of 11%.
Previous studies have suggested that minority groups and people in rural areas are less likely to receive preventive health care services than nonminority and urban individuals, which may partly account for geographic differences in cancer mortality. Relatively few studies (36) have examined the cancer mortality experiences of minorities who live in specific rural areas, however. The present analysis provides important information about breast and cervical cancer mortality among women in the Mississippi Delta, including mortality patterns among black women in the rural South. In addition, we found that among some groups, mortality was higher among urban women. Interventions need to be implemented that target specific population groups on the community level and are culturally appropriate. Examples of such interventions that may serve as models are the community cancer control initiatives of the Appalachia Leadership Initiative on Cancer (37) and those that address specific barriers to screening. (38-40)
With respect to study limitations, we defined geographic area of residence as urban, suburban, or rural using county-level data from the census and US Department of Agriculture codes (Beale codes For the cipher texts, see .
In geography, a Beale code was originally an American classification of geography originally developed by Calvin Beale at the United States Department of Agriculture in 1975. (1). ). Although Beale codes are widely used to classify clas·si·fy
tr.v. clas·si·fied, clas·si·fy·ing, clas·si·fies
1. To arrange or organize according to class or category.
2. To designate (a document, for example) as confidential, secret, or top secret. geographic area of residence, rurality based upon population counts of geopolitical ge·o·pol·i·tics
n. (used with a sing. verb)
1. The study of the relationship among politics and geography, demography, and economics, especially with respect to the foreign policy of a nation.
a. units may introduce misclassification. (13) Counties vary in size and in some large counties, many residents live in urban areas even though large numbers of persons live in rural areas of those same counties. (13) Such misclassification may have partly obscured the observed differences in cancer mortality in the present study.
Although the reliance on death certificates is a further limitation, studies of the accuracy of death certificates in the United States have shown breast and cervical cancer to be valid underlying causes of death. (41,42) Data on the proportion of women in the Delta who have undergone hysterectomy hysterectomy (hĭstərĕk`təmē), surgical removal of the uterus. A hysterectomy may involve removal of the uterus only or additional removal of the cervix (base of the uterus), fallopian tubes (salpingectomy), and ovaries are currently lacking, and trends in cervical cancer mortality may be affected by trends in hysterectomy with removal of the cervix cervix /cer·vix/ (ser´viks) pl. cer´vices [L.]
2. the front portion of the neck.
3. cervix uteri. . Hysterectomy rates differ by state, race, ethnicity, and socioeconomic status. (43) Similarly, differences in cervical cancer death rates by race, rurality, and socioeconomic distress may be partly due to differences in hysterectomy rates. Access to state-of-the-art treatment for invasive cervical cancer may also account for such differences. Finally, results from joinpoint analyses are influenced by the number of years included, and assume that rate changes are constant over a time interval.
We found that women of some areas in the Mississippi Delta have higher breast and cervical cancer death rates than their counterparts elsewhere in the United States. Mortality trends in breast and cervical cancer may provide information to guide prevention and control activities for reducing premature mortality from these diseases.
Table 1. Death rates from cancer of the breast, by region and age (yr), 1979-1998 (a) Mississippi Delta <50 50-69 [greater than or equal to]70 1979 5.6 62.4 93.2 1980 5.7 64.2 98.5 1981 5.3 71.4 92.3 1982 5.5 67.8 98.6 1983 6.4 62.5 99.8 1984 6.0 65.3 107.0 1985 6.8 67.8 123.5 1986 6.3 70.5 97.3 1987 6.2 67.8 120.5 1988 7.3 73.1 123.8 1989 8.4 71.6 123.8 1990 8.2 73.2 130.1 1991 8.1 70.5 134.9 1992 8.4 72.0 127.5 1993 7.7 67.0 134.0 1994 8.2 64.7 131.5 1995 8.8 69.5 126.9 1996 7.9 67.0 128.7 1997 8.0 67.4 127.3 1998 7.1 61.8 131.8 EAPC and JP EAPC 3.2 1.1 3.1 95% CI 2.3, 4.1 0.3, 2.0 2.1, 4.2 JP 1995 1990 1991 EAPC -6.8 -1.5 -0.4 95% CI -16.4, 3.9 -2.9, -0.1 -2.7, 2.0 JP EAPC 95% CI JP EAPC 95% CI Other US <50 50-69 [greater than or equal to]70+ 1979 6.2 76.6 122.7 1980 6.1 78.3 125.2 1981 6.1 78.4 128.7 1982 6.2 79.0 131.5 1983 6.1 79.8 132.3 1984 6.6 81.0 136.0 1985 6.6 81.5 135.9 1986 6.8 80.4 137.9 1987 6.9 80.1 137.2 1988 6.9 80.8 141.7 1989 7.1 79.5 144.8 1990 7.2 79.2 145.0 1991 7.2 78.0 144.1 1992 7.0 74.4 142.7 1993 6.8 72.6 146.0 1994 6.9 70.7 144.8 1995 7.0 69.4 143.7 1996 6.9 66.0 141.8 1997 6.7 62.7 135.1 1998 6.4 60.5 135.1 EAPC and JP EAPC 1.7 0.9 1.5 95% CI 1.2, 2.2 0.5, 1.3 1.2, 1.8 JP 1990 1985 1989 EAPC -1.1 -0.5 0 95% CI -1.8, -0.3 -1.3, -.3 -0.9, 0.9 JP 1990 1995 EAPC -2.8 -2.5 95% CI -3.5, -2.0 -4.4, -0.5 JP 1995 EAPC -4.4 95% CI -5.5, -3.2 (a) Rates are per 100,000 women. JP, joint points: EAPC, estimated annual percent change; CI, 95% confidence interval. Table 2. Average annual deaths from cancer of the breast and cervix in the Mississippi Delta counties within Delta states and comparison of Delta counties with non-Delta counties, 1994-1998 (a) Breast Count Rate (b) 95% CI D (c) P Alabama 261 21.9 19.2, 24.9 -0.3 0.84 Arkansas 1,131 23.4 22.0, 24.9 2.9 <0.01 Illinois 301 21.9 19.2, 24.8 -4.2 <0.01 Kentucky 405 22.0 19.8, 24.5 -2.1 0.11 Louisiana 2,387 25.5 24.4, 26.6 -0.2 0.83 Mississippi 1,089 24.0 22.5, 25.5 1.4 0.22 Missouri 567 23.8 21.8, 26.0 -0.1 0.93 Tennessee 1,241 26.6 25.1, 28.2 3.1 <0.01 Total 7.382 24.5 23.9, 25.1 Cervix Count Rate (b) 95% CI D (c) P Alabama 49 4.1 3.0, 5.6 1.30 0.03 Arkansas 149 3.3 2.8, 4.0 0.10 0.81 Illinois 57 4.4 3.2, 5.9 1.60 0.01 Kentucky 41 2.6 1.8, 3.6 -1.00 0.03 Louisiana 339 3.7 3.3, 4.1 0.20 0.58 Mississippi 175 3.9 3.4, 4.6 1.00 0.02 Missouri 80 3.8 3.0, 4.8 1.10 0.01 Tennessee 193 4.3 3.7, 5.0 1.20 <0.01 Total 1,083 3.7 3.5, 4.0 (a) CI, confidence interval. (b) Rates are per 100,000 and age adjusted to the 1970 US standard population. (c) Difference between the rate in the Mississippi Delta region within the state and the rate for the remainder of the state. Table 3. Average annual death rates from cancer of the breast and cervix, by race and region, United States, 1994-1998 (a) White women MS Delta Other US Count Rate (b) 95% CI Count Rate Breast County economic status (c) Distressed 1,515 22.3 21.1, 23.5 6,345 22.3 Nondistressed 3,623 22.4 21.6, 23.2 171,589 23.9 Rurality (d) Urban 2,225 22.8 21.9, 23.8 140,639 24.1 Suburban 602 23.0 21.1, 25.1 11,456 23.3 Rural 2,311 21.9 20.9, 22.8 26,194 22.6 Cervix County economic status (c) Distressed 198 3.3 2.8, 3.8 1,002 3.7 Nondistressed 379 2.5 2.3, 2.8 155,293 2.3 Rurality (d) Urban 200 2.1 1.8, 2.5 12,419 2.3 Suburban 80 3.4 2.7, 4.4 1,084 2.4 Rural 297 3.2 2.8, 3.6 2,819 2.7 White women Black women Other US MS Delta 95% CI P Count Rate 95% CI Breast County economic status (c) Distressed 21.7, 22.8 0.97 761 28.1 26.1, 30.3 Nondistressed 23.8, 24.0 <0.01 1,468 32.8 31.1, 34.6 Rurality (d) Urban 24.0, 24.2 0.01 1,307 32.7 30.9, 34.6 Suburban 22.9, 23.8 0.76 211 32.5 28.1, 37.4 Rural 22.3,, 22.9 0.16 711 28.0 25.9, 30.3 Cervix County economic status (c) Distressed 3.5, 4.0 0.10 177 6.2 5.3, 7.3 Nondistressed 2.3, 2.3 0.10 321 7.1 6.3, 7.9 Rurality (d) Urban 2.2, 2.3 0.34 297 7.4 6.5, 8.3 Suburban 2.3, 2.6 0.01 39 5.8 4.1, 8.1 Rural 2.6, 2.8 0.03 162 6.1 5.1, 7.2 Black women Other US Count Rate 95% CI P Breast County economic status (c) Distressed 1,287 29.5 27.8, 31.2 0.32 Nondistressed 22,473 31.0 30.6, 31.4 0.05 Rurality (d) Urban 20,987 31.2 30.8, 31.6 0.11 Suburban 766 28.6 26.6, 30.8 0.13 Rural 2,116 29.6 28.3, 30.9 0.24 Cervix County economic status (c) Distressed 239 5.5 4.8, 6.2 0.20 Nondistressed 3,926 5.2 5.0, 5.4 <0.01 Rurality (d) Urban 3,616 5.2 5.0, 5.3 <0.01 Suburban 145 5.2 4.4, 6.2 0.60 Rural 420 5.9 5.4, 6.6 0.79 (a) MS. Mississippi: CI, confidence interval. (b) Rates are per 100,000 population and are age adjusted to the 1970 US standard population. (c) Counties were defined as distressed if they had a 3-year (1997-1999) average unemployment rate at least 1.5 times (150%) the US average of 4.6%, a per capita income that was less than two-thirds (67%) of the US average of $23.564: and had a poverty rate that was at least 1.5 times (150%) the US average of 13.1% or had 2 times (200%) the poverty rate. (d) Beale codes 1993. Table 4. Death rates from cervical cancer, by region and age (yr), 1979-1998 (a) Delta Other US <50 50-69 [greater than or equal to]70 <50 50-69 1979 2.4 9.7 15.7 1.4 10.0 1980 2.1 10.7 17.4 1.5 9.4 1981 1.8 10.3 15.6 1.4 9.4 1982 1.7 9.9 16.2 1.4 8.8 1983 1.7 11.3 18.8 1.4 8.7 1984 2.2 9.6 14.5 1.4 8.2 1985 2.1 8.1 20.8 1.4 7.9 1986 2.1 10.2 16.1 1.5 8.2 1987 2.0 10.5 13.6 1.5 7.5 1988 1.7 8.0 15.1 1.5 7.6 1989 2.0 8.8 17.2 1.5 7.5 1990 1.9 8.9 13.8 1.6 7.5 1991 1.9 8.5 15.6 1.6 7.3 1992 2.5 9.1 13.6 1.6 7.1 1993 2.2 8.2 14.1 1.6 6.9 1994 2.5 9.9 11.7 1.6 7.1 1995 2.2 8.3 13.0 1.6 6.4 1996 2.3 8.5 13.2 1.6 6.9 1997 2.6 9.2 11.6 1.6 6.6 1998 2.0 8.5 13.6 1.6 5.9 EAPC and JP EAPC 0.9 -1.0 -1.7 -0.5 -2.2 95% CI -0.1, -1.7, -2.6, -2.1, -2.5, 1.9 -0.3 -0.9 1.1 -1.9 JP 1984 EAPC 2.0 95% CI 0.7, 3.2 JP 1991 EAPC 0 95% CI -1.0, 1.0 Other US [greater than or equal to]70 1979 14.9 1980 14.3 1981 13.8 1982 13.0 1983 12.5 1984 12.1 1985 12.1 1986 11.2 1987 10.9 1988 10.9 1989 10.6 1990 10.6 1991 10.1 1992 10.4 1993 10.3 1994 9.5 1995 9.7 1996 9.0 1997 8.4 1998 8.2 EAPC and JP EAPC -3.8 95% CI -4.5, -3 JP 1987 EAPC -1.1 95% CI -2.6, 0.5 JP 1993 EAPC -4.3 95% CI -5.8, -2.8 (a) Rates are per 100,000 women, JP, joint points; EAPC, estimated annual percent changes; CI, confidence interval.
Accepted September 29, 2003.
Copyright [c] 2004 by The Southern Medical Association
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RELATED ARTICLE: Key Points
* Breast cancer mortality in the Mississippi Delta region was similar to that elsewhere in the United States in recent years for both black and white women, but rates were lower in the Delta in the early years of the study period.
* Overall, cervical cancer mortality was similar in the two areas but rates declined more rapidly elsewhere in the United States than in the Mississippi Delta region.
* Breast and cervical cancer mortality was higher among black women than among white women in both areas.
H. Irene Hall, PHD, Patricia M. Jamison, MPH MPH Master of Public Health.
MPH Master's Degree in Public Health , and Steven S Ste´ven
n. 1. Voice; speech; language.
Ye have as merry a steven
As any angel hath that is in heaven.
2. An outcry; a loud call; a clamor.
To set steven
to make an appointment. . Coughlin, PHD
From the Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
This work was conducted by employees of the US government.
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