Abstract C008: Associations of county-level structural racism indices with cancer mortality disparities in Florida

Abstract

Abstract Existing multidimensional measures of structural racism are largely measured on the state level, which may mask underlying heterogeneity on smaller levels of geography. This study pilots an empirical approach to operationalizing structural racism in cancer equity research by introducing an association-sensitive inequality index developed to capture county-level structural racism, utilizing the state of Florida as an empirical case study. Three structural racism indices per county were constructed, incorporating comparisons between (a) non-Hispanic/Latinx Blacks and non-Hispanic/Latinx whites, (b) Hispanics/Latinx and non-Hispanic/Latinx whites, and (c) non-Hispanic/Latinx Blacks and Hispanics/Latinx. Unadjusted and adjusted regression models were fit to assess the ecological association between the structural racism indices and race/ethnicity-specific measures of (1) age-adjusted all-cause mortality, (2) age-adjusted overall cancer mortality, (3) age-adjusted lung cancer mortality, (4) age-adjusted breast cancer mortality, and (5) prevalence of late stage cancer diagnosis. Unadjusted and adjusted Poisson regression models were fit to assess the ecological association between the structural racism indices and race/ethnicity-specific measures of (1) age-adjusted all-cause mortality, (2) age-adjusted overall cancer mortality, (3) age-adjusted lung cancer mortality, (4) age-adjusted breast cancer mortality, and (5) prevalence of late stage cancer diagnosis. In fully adjusted models, county-level Black-white structural racism was associated with higher levels of all-cause, overall cancer, lung cancer, and breast cancer mortality rates among Black residents (p<0·0001), higher levels of all-cause mortality in white residents (p<0·0001). County- level Latinx-white structural racism was associated with lower levels of all-cause and overall cancer mortality and slightly higher lung cancer mortality among Hispanic/Latinx residents, and higher levels of all-cause mortality and lower levels of overall cancer mortality among white residents. This study provides evidence of structural racism impacts among cancer disparities within Black and Hispanic/Latinx communities, an understudied population in empirical structural racism literature. Study findings demonstrate that the relationship between the Black-white structural racism index and the health outcomes of interest correspond best with a “universal harm” relationship, whereby both Black and white Floridians experienced increased negative health outcomes associated with increasing levels of structural racism. Citation Format: Zinzi D. Bailey, Marlene Camacho-Rivera, Kasim Ortiz. Associations of county-level structural racism indices with cancer mortality disparities in Florida [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C008.