ASPO Abstracts
Multilevel health disparities in cancer mortality, 1969-2014: Uncovering the role of county-level persistent poverty
Category: Cancer Health Disparities
Conference Year: 2019
Abstract Body:
Purpose. To determine the independent and interacting risks of cancer mortality associated with county-level persistent poverty, county-level metropolitan status, and individual-level race with cancer mortality rates in order to monitor geographic health disparities.Methods. Records from the National Death Index (1969-2014) were used to gather individual-level data on race/ethnicity and cancer deaths (breast and cervical (females only); prostate (males only); lung and bronchus; colorectal; oropharyngeal; stomach; liver and intrahepatic bile duct). These records were linked to participants’ county of residence, which were classified as (a) persistently impoverished or non-impoverished and (b) metro or non-metro, using data from the U.S. Department of Agriculture. We analyzed trends in cancer mortality across these categories over the study period, including analysis of joinpoints and health disparities. Results. Mortality rates for most cancers were higher in impoverished than non-impoverished counties (range: 2% for colorectal to 52% for cervical) and for blacks compared to whites (range: 14% for lung and bronchus to 131% for cervical); however, differences in mortality by metropolitan status were mixed (range: -15% for stomach to 16% for cervical). Black individuals in impoverished counties had particularly high cancer mortality rates. Declines in cancer mortality over the study period were attenuated in impoverished compared to non-impoverished counties for colorectal (-47%), breast (-57%), and stomach (-19%) cancers (all p<.05). By 2014, absolute and relative health disparities in cancer mortality were apparent for almost all cancers, with higher mortality concentrated in impoverished counties.Conclusions. Disparities in cancer mortality for impoverished compared to non-impoverished counties were wide and enduring over the last 45 years. These differences interacted with other risk factors, including race/ethnicity and metropolitan status. Additional etiologic research is needed to inform interventions to improve cancer prevention and control in these vulnerable areas.
Keywords: Cancer mortality; persistent poverty; disparities; rural health; race