Abstract
We analyzed socioeconomic and racial/ethnic disparities in US mortality, incidence, and survival rates from all-cancers combined and major cancers from 1950 to 2014. Census-based deprivation indices were linked to national mortality and cancer data for area-based socioeconomic patterns in mortality, incidence, and survival. The National Longitudinal Mortality Study was used to analyze individual-level socioeconomic and racial/ethnic patterns in mortality. Rates, risk-ratios, least squares, log-linear, and Cox regression were used to examine trends and differentials. Socioeconomic patterns in all-cancer, lung, and colorectal cancer mortality changed dramatically over time. Individuals in more deprived areas or lower education and income groups had higher mortality and incidence rates than their more affluent counterparts, with excess risk being particularly marked for lung, colorectal, cervical, stomach, and liver cancer. Education and income inequalities in mortality from all-cancers, lung, prostate, and cervical cancer increased during 1979–2011. Socioeconomic inequalities in cancer mortality widened as mortality in lower socioeconomic groups/areas declined more slowly. Mortality was higher among Blacks and lower among Asian/Pacific Islanders and Hispanics than Whites. Cancer patient survival was significantly lower in more deprived neighborhoods and among most ethnic-minority groups. Cancer mortality and incidence disparities may reflect inequalities in smoking, obesity, physical inactivity, diet, alcohol use, screening, and treatment.
Highlights
Monitoring and reducing health disparities according to socioeconomic status (SES) and race/ethnicity have long been an important health policy goal in the United States [1,2,3].and incidence and mortality from major cancers has changed markedly during the past 5 decades [4,5,6,7]
We examined disparities in cancer mortality, incidence, and survival using three national data sources: the national mortality database, the 1979–2011 National Longitudinal Mortality Study (NLMS), and the SEER cancer registry database
The correlation between area-level SES and all-cancer mortality rates changed from +0.55 in 1950 to −0.52 in 2014
Summary
Monitoring and reducing health disparities according to socioeconomic status (SES) and race/ethnicity have long been an important health policy goal in the United States [1,2,3].and incidence and mortality from major cancers has changed markedly during the past 5 decades [4,5,6,7]. Temporal patterns have changed largely as a result of differential rates of decline or increase in mortality among those in various socioeconomic groups and changing sociodemographic patterns in major cancer risk factors such as smoking, diet, obesity, and physical inactivity [3,4,5,6]. The major behavioral determinants of cancer, such as smoking, diet, alcohol use, obesity, physical inactivity, reproductive behavior, occupational and environmental exposures, and cancer screening, are themselves substantially influenced by individual-level and area-level socioeconomic factors [2, 3, 6, 7, 15, 18– 20]. Analyzing socioeconomic and racial/ethnic patterns in cancer mortality and incidence is important because it allows us to quantify cancer-related health disparities between the least- and most-advantaged social groups and to identify areas or population groups that are at greatest risk of cancer diagnosis and mortality and who may benefit from targeted social and medical interventions [3, 6]. Comparison of cancer trends across population groups or areas may provide important insights into the impact of cancer control interventions, such as smoking cessation, cancer screening, physical activity campaigns, and cancer treatment [3,4,5,6,7, 10]
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