Disparities in cervical cancer incidence and neighborhood socioeconomic inequality in New York City

Abstract

<h3>Objectives:</h3> In the United States, access to healthcare services is linked to socioeconomic status (SES). Cervical cancer is a preventable malignancy, and risk of developing the disease is linked to accessibility of preventive services such as screening and vaccination. The purpose of this study is to examine the association between neighborhood SES and the incidence of cervical cancer in women in New York City. <h3>Methods:</h3> We conducted a population-based, cross-sectional study of women residing in New York City from 2012-2016. We abstracted cases of cervical cancer and age-adjusted incidence rates by neighborhood (defined in terms of 55 Public Use Microdata Areas) from the New York State Cancer Registry and linked these data with the US Census Bureau's American Community Survey. We calculated an SES index for each neighborhood using a weighted combination of measures of crowding, real-estate values, poverty rates, incomes, educational attainment, and unemployment, which was developed and validated by the Agency for Healthcare Research and Quality. We fit a Poisson regression model with robust standard errors to estimate the association between cervical cancer incidence and neighborhood SES index, modeling SES as a continuous variable. We estimated the incidence rates, and rate ratio, associated with residence in lowest SES neighborhoods (10th percentile) compared with highest SES neighborhoods (90th percentile). <h3>Results:</h3> There were 932 cases of cervical cancer diagnosed between 2012-2016, corresponding to an age-adjusted incidence rate of 9.1 cases per 100,000 women years (95% CI 8.7-9.5). There was variation in age-adjusted cervical cancer incidence rates by neighborhoods, ranging from 4.4 cases (95% CI 2.9-7.4) to 14.7 cases (95% CI 10.8-19.5) per 100,000 women years. We identified substantial variation in socioeconomic and demographic factors among neighborhoods. Neighborhoods with the highest SES index values (top decile) were predominately populated by white residents (68.9%), with relatively few Hispanic (11.6%) and Black residents (4.5%). Conversely lowest SES index neighborhoods (bottom decile) were principally populated by Hispanic (60.1%) and Black residents (33.5%), and few White residents (3.0%). Neighborhood SES index was strongly associated with cervical cancer incidence. After adjustment for age, women residing in the lowest SES neighborhoods were 73% more likely to develop cervical cancer than those in the highest SES neighborhoods (inter-decile incidence rate ratio 1.73, 1.52-1.96, p<0.001) corresponding to incidence rates of 11.2 (95% CI, 10.3-12.2) and 6.5 (95% CI 5.9-7.1) cases per 100,000 women years respectively. <h3>Conclusions:</h3> In New York City, cervical cancer rates in neighborhoods with low SES are substantially higher than those in neighborhoods with high SES, despite their geographic proximity. Neighborhood-level preventive interventions may be an important component in eliminating inequities in cervical cancer incidence.