ArticleHealth information science and systems2021
Naïve Bayesian network-based contribution analysis of tumor biology and healthcare factors to racial disparity in breast cancer stage-at-diagnosis.
Article in Health information science and systems, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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6 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Bayesian inference in racial health inequity analyses for noncommunicable diseases: a systematic review.Systematic reviews · 2025Pooled it
- Survival differences in malignant meningiomas: a latent class analysis using SEER data.Discover oncology · 2025Article
- Inherent Bias in Electronic Health Records: A Scoping Review of Sources of Bias.medRxiv : the preprint server for health sciences · 2024Article
- Social determinants of health and health inequities in breast cancer screening: a scoping review.Frontiers in public health · 2024Article
- A Bayesian network perspective on neonatal pneumonia in pregnant women with diabetes mellitus.BMC medical research methodology · 2023Article
- Clinical Informatics Approaches to Understand and Address Cancer Disparities.Yearbook of medical informatics · 2022Review
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Abstract
backgroundVariation in breast cancer stage at initial diagnosis (including racial disparities) is driven both by tumor biology and healthcare factors.
methodsWe studied women age 67-74 with initial diagnosis of breast cancer from 2006 through 2014 in the SEER-Medicare database. We extracted variables related to tumor biology (histologic grade and hormone receptor status) and healthcare factors (screening mammography [SM] utilization and time delay from mammography to diagnostic biopsy). We used naïve Bayesian networks (NBNs) to illustrate the relationships among patient-specific factors and stage-at-diagnosis for African American (AA) and white patients separately. After identifying and controlling confounders, we conducted counterfactual inference through the NBN, resulting in an unbiased evaluation of the causal effects of individual factors on the expected utility of stage-at-diagnosis. An NBN-based decomposition mechanism was developed to evaluate the contributions of each patient-specific factor to an actual racial disparity in stage-at-diagnosis. 2000 bootstrap samples from our training patients were used to compute the 95% confidence intervals (CIs) of these contributions.
resultsUsing a causal-effect contribution analysis, the relative contributions of each patient-specific factor to the actual racial disparity in stage-at-diagnosis were as follows: tumor grade, 45.1% (95% CI: 44.5%, 45.8%); hormone receptor status, 5.0% (4.5%, 5.4%); mammography utilization, 23.1% (22.4%, 24.0%); and biopsy delay 26.8% (26.1%, 27.3%).
conclusionThe modifiable mechanisms of mammography utilization and biopsy delay drive about 49.9% of racial difference in stage-at-diagnosis, potentially guiding more targeted interventions to eliminate cancer outcome disparities. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13755-021-00165-5.
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