ASPO Abstracts
The Association of Neighborhood-level Social Class and Tobacco Consumption with Adverse Lung Cancer Characteristics in Maryland
Category: Cancer Health Disparities
Conference Year: 2019
Abstract Body:
Introduction Although both active tobacco use and passive tobacco exposure are well-established riskfactors for lung cancer, it is challenging to measure tobacco-related exposures at thepopulation level, while considering other factors (gender, race, socio-economic status)which may modify the relationship between tobacco and lung cancer. Moreover, research todate has focused primarily on relationships between tobacco and endpoints of lung cancerincidence or mortality. Tobacco’s role in disease progression, through association withimportant disease characteristics such as tumor histologic type and grade, and stage ofdisease at diagnosis, is less well examined. Methods This research examines associations between area-level tobacco use and social class, aswell as individual gender, race and age, and three adverse disease characteristics (tumortype, grade and stage) among incident cases of lung cancer reported to the Maryland CancerRegistry in 2000. Cases were geocoded by residential address. Multi-level logisticregression models included Census block group-level estimates of per capita tobaccospending, from Consumer Expenditure Survey data, and a four-item social class index, fromCensus estimates of rates of high school graduation, employment, white collar occupation,and per capita income. Results Analyses of 3223 cases found no significant differences by race; however, resultsdiffered by gender. Lower block group social class and higher tobacco spending wereassociated with squamous and small cell histological types and poorly differentiated orundifferentiated tumor grade. However, for later stage at diagnosis (SEER stages 2-7),both higher social class and greater tobacco spending were protective, especially forwomen, suggesting women in high tobacco use communities may benefit from early detection. Conclusions Results support using area-level behavioral data as tools for identifying high riskcommunities suitable for more resource-intensive research or interventions. Findings alsosuggest that area-level social resources are consistent drivers of lung cancerdisparities, and merit continued research attention.
Keywords: Disparities, SocialClass, Tobacco,Area-Level, LungCancer