The impact of economic recession on the incidence and treatment of cancer.

Abstract

6005 Background: Normal fluctuations of the economy result in periods of recession. This study investigated the relationship between these periods and the incidence and treatment of cancer. We assessed if this relationship differs based on type of cancer, and racial/socioeconomic groups. We hypothesized that this effect would be greatest for cancers for which screening is common or often present with easily minimized symptoms. Methods: Data on incidence and treatment (radiation therapy [RT], surgery) for all cancers, and breast and pancreatic specifically, were collected using the Surveillance Epidemiology and End Results (SEER) database for 1973-2007. The data was subsequently divided by race (AA, White, other) and into quartiles for socioeconomic sub-groups: household income, percent with high school education. Unemployment rate by month was found on the Bureau of Labor Statistics website and used as the measure of economic recession. Data was log transformed; and multivariate linear regression was used to analyze the data. Results: Adjusting for race and socioeconomic factors, the rates of cancer incidence, treatment with RT and treatment with surgery for all cancers revealed a significant inverse correlation with unemployment (p<0.0001). Every 1% increase in unemployment is associated with a 3% (95% CI: 2.1-3.3%) decline in cancer incidence, 9% (7-10.4%) decrease in RT, and 12% (9.7-14.6%) decline in surgery. Breast cancer incidence and treatment had a dramatic relationship (p<.0001, 7 [5.7-9.1]%, 17 [15.4-18.2]%, 24 [22.2-25.5]%, respectively). For pancreatic cancer, there was less of a relationship for incidence (p=0.059, 1 [-0.1-2.7]% for every 1% change in unemployment), RT (p<0.001, 1 [0.8-2.1]%) and surgery (p<0.0001, 9 [7.6-9.4]%). Models testing for a disparity in the effects of the economy due to race or socioeconomic groups yielded no discernable trends. Conclusions: Independent of socioeconomic status, increasing unemployment rates during times of economic recession are associated with a decline in the incidence and treatment of all cancers. This effect is more pronounced for cancers that often have lesser symptoms (e.g. breast cancer) and is less evident for cancers that present with severe symptoms (e.g. pancreas).