Quantification of Potential Inequities in Breast Cancer Incidence in New Mexico Through Bayesian Disease Mapping

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The SEER registry yielded 39,293 people living in New Mexico aged 15 or older who received a diagnosis of breast cancer, 38,977 of which were women. Of these, 13,135 were diagnosed from 2005 through 2014. County of residence was known for 12,974 of these. Among those with known county of residence, 8,794 were non-Hispanic, and 8,461 were American Indian/Alaska Native (567) or White (7,894).

Figure 1.
Data flow diagram describing the selection of New Mexico women with breast cancer for inclusion in a study of potential inequities in breast cancer incidence among non-Hispanic American Indian/Alaska Native and non-Hispanic White women. Abbreviation: SEER, Surveillance, Epidemiology, and End Results program.

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Figure 2.
County-level Area Deprivation Index (ADI) quintiles for 33 New Mexico counties in 2012 categorized as the lower 20% (Q1), middle 60% (Q 2–4), and upper 20% (Q5). Higher quintiles indicate increased socioeconomic disadvantage. Red diamonds depict major cites (Albuquerque in Bernalillo County, Las Cruces in Dona Ana County, Rio Rancho in Sandoval County, and Santa Fe in Santa Fe County). ADI scores were developed by Mayo Clinic researchers (10), and are derived from 17 indicators that served as surrogates for income, employment, housing, and education.

County-level Area Deprivation Index (ADI) quintiles for 33 New Mexico counties in 2012 categorized as the lower 20% (Q1), middle 60% (Q 2–4), and upper 20% (Q5). Higher quintiles indicate increased socioeconomic disadvantage. Red diamonds depict major cites (Albuquerque in Bernalillo County, Las Cruces in Dona Ana County, Rio Rancho in Sandoval County, and Santa Fe in Santa Fe County). ADI scores were developed by Mayo Clinic researchers (10), and are derived from 17 indicators that served as surrogates for income, employment, housing, and education.

County	Rate Ratio, Non-Hispanic AI/AN vs Non-Hispanic White Women
	Posterior Mean Rate Ratio (95% Credible Interval Rate Ratio)
Bernalillo	0.311 (0.121–0.600)
Catron	0.346 (0.066–0.927)
Chaves	0.446 (0.092–0.991)
Cibola	0.440 (0.175–0.834)
Colfax	0.488 (0.109–1.284)
Curry	0.490 (0.064–1.348)
De Baca	0.460 (0.095–1.073)
Dona Ana	0.407 (0.066–0.910)
Eddy	0.372 (0.058–1.061)
Grant	0.432 (0.067–1.062)
Guadalupe	0.456 (0.108–1.037)
Harding	0.477 (0.112–1.162)
Hidalgo	0.492 (0.048–1.436)
Lea	0.480 (0.069–1.215)
Lincoln	0.335 (0.081–0.822)
Los Alamos	0.370 (0.080–1.072)
Luna	0.432 (0.063–1.058)
McKinley	0.462 (0.228–0.808)
Mora	0.460 (0.132–1.044)
Otero	0.437 (0.112–0.930)
Quay	0.455 (0.109–1.026)
Rio Arriba	0.416 (0.131–0.816)
Roosevelt	0.463 (0.085–1.087)
San Juan	0.478 (0.250–0.820)
San Miguel	0.465 (0.132–1.078)
Sandoval	0.339 (0.120–0.715)
Santa Fe	0.326 (0.106–0.737)
Sierra	0.419 (0.092–0.903)
Socorro	0.422 (0.106–0.860)
Taos	0.492 (0.139–1.296)
Torrance	0.432 (0.123–0.889)
Union	0.499 (0.092–1.341)
Valencia	0.421 (0.100–0.882)

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Figure 3.
Exponentiated sum of the posterior average county-level heterogeneity effects obtained from the proposed model. Map A gives the results for non-Hispanic White women and Map B gives the results for non-Hispanic American Indian/Alaska Native women. Red diamonds depict major cites (Albuquerque in Bernalillo County, Las Cruces in Dona Ana County, Rio Rancho in Sandoval County, and Santa Fe in Santa Fe County).

Exponentiated sum of the posterior average county-level heterogeneity effects obtained from the proposed model. Map A gives the results for non-Hispanic White women and Map B gives the results for non-Hispanic American Indian/Alaska Native women. Red diamonds depict major cites (Albuquerque in Bernalillo County, Las Cruces in Dona Ana County, Rio Rancho in Sandoval County, and Santa Fe in Santa Fe County).

County	Exponentiated Sum of the Posterior Average County-Level Heterogeneity Effects, EXP(Φ+Θ), Obtained From the Proposed Model
	Non-Hispanic White Women	Non-Hispanic American Indian/Alaska Native Women
Bernalillo	1.003	0.996
Catron	0.995	0.960
Chaves	0.963	0.947
Cibola	1.012	1.055
Colfax	1.029	1.074
Curry	0.960	0.952
De Baca	0.972	0.976
Dona Ana	1.002	0.880
Eddy	0.914	0.928
Grant	1.010	0.921
Guadalupe	0.991	0.999
Harding	1.011	1.050
Hidalgo	0.983	0.913
Lea	0.928	0.927
Lincoln	0.977	0.964
Los Alamos	1.050	1.069
Luna	1.001	0.909
McKinley	1.010	1.133
Mora	1.039	1.071
Otero	0.993	0.981
Quay	0.990	1.002
Rio Arriba	1.042	1.008
Roosevelt	0.954	0.955
San Juan	0.992	1.158
San Miguel	1.027	1.073
Sandoval	1.010	1.070
Santa Fe	1.074	1.075
Sierra	1.001	0.935
Socorro	0.991	0.952
Taos	1.073	1.162
Torrance	1.009	0.997
Union	1.010	1.040
Valencia	1.003	0.953

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