Table 1.

Multilevel Model Variables: Description, Rationale, and Sample Statistics.

Variable (Units of Measure)	Rationale for Inclusion	Sample Statistics
		Mean (Proportion)	Standard Deviation
Outcome: whether cancer patient was diagnosed at a late stage (regional or distant = 1, else = 0)	Late stage diagnosis is indicative of lack of knowledge regarding personal cancer risk, or the importance or availability of screening; lack of timely or proximate access to services, lack of funds to pay for, and cultural or other barriers related to utilization of timely cancer screening	0.308	0.461
Person-level predictors
African American	The national statistics cite African Americans as a disadvantaged group, with higher likelihood of late-stage BC than whites, the reference group	0.101	0.301
Hispanic	The national statistics cite Hispanics as a disadvantaged group, with higher likelihood of late-stage BC than whites, the reference group	0.081	0.273
Asian	The national statistics cite Asians as an advantaged group, with lower likelihood of late-stage BC than whites, the reference group	0.033	0.178
White (reference category)	The reference group	0.773	0.419
Race all others		0.013	0.112
age < 50	BC screening protocols recommend to start screening at age <50 for high risk individuals	0.226	0.223
age 50–64	BC screening protocols recommend to start screening at age 50 for average risk individuals; this is the prime age bracket for screening	0.366	0.397
age 65–74	Medicare insurance coverage begins at age 65 for people who are eligible for Social Security benefits	0.219	0.425
age 75+ (reference category)	Screening is not needed or recommended as often for older individuals who have had regular screening at younger ages	0.189	0.463
County-level predictors
Isolation index white	This index reflects the degree to which whites are proximate to other whites in their county of residence (2000)	0.774	0.144
Isolation index African American	This index reflects the degree to which African Americans are proximate to other African Americans in their county of residence (2000)	0.101	0.301
Isolation index Hispanic	This index reflects the degree to which Hispanics are proximate to other Hispanics in their county of residence (2000)	0.216	0.203
Isolation index Asian	This index reflects the degree to which Asians are proximate to other Asians in their county of residence (2000)	0.073	0.086
Person-centered isolation measure	This constructed measure matches the area-level Isolation Index to the person based on race or ethnicity, and reflects the degree to which people are proximate to others of their same race or ethnicity (2000)	0.716	0.225
Managed care penetration (%)	Managed care has transformed the way medicine is practiced in highly-penetrated markets, with preventive care services more prevalent/utilized more intensively (2005)	15.9	14.7
Distance (miles)	Calculated as the average distance (miles) over all ZIP codes with centroid in the county to closest mammography provider ZIP code. Greater distance to closest provider of BC (mammogram) screening suggests impeded access to preventive care services. Based on 100% Fee for Service (FFS) Medicare utilization of mammography services (2006)	6.02	6.10
Screening rate (%)	Percent of the 100% FFS Medicare population residing in the county and alive all year that utilized cancer screening (mammography) (2006)	23.60	3.18
Percent uninsured (%)	% of the under-age-65 population who did not have health insurance (2005)	17.73	5.45
State-Level Policy Variable Direct Access to Specialist (1 = yes, 0 = no) in 2004	Access to a specialist without need of referral from a primary care physician may result in better matching and more timely care. Hypothesized to increase access for less well insured individuals or those in more stringent managed care plans. Younger people tend to be enrolled in these more stringent managed care plans, which are less costly but restrict access and choice. Source: NCSL, 2010	Six out of the 40 states did not have Mandate: ND, SD, NE, IA, WY, OK