Individual- And county-level determinants of high breast cancer incidence rates

Mario Schootman, Kendra Ratnapradipa, Travis Loux, Allese McVay, L. Joseph Su, Erik Nelson, Susan Kadlubar

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)S323-S333
JournalTranslational Cancer Research
StatePublished - 2019
Externally publishedYes


  • Breast neoplasms
  • Geography
  • Healthcare disparities
  • Neighborhood
  • Risk assessment

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


Dive into the research topics of 'Individual- And county-level determinants of high breast cancer incidence rates'. Together they form a unique fingerprint.

Cite this