ASPO Abstracts
An assessment of poverty and cancer survival in a state registry
Category: Cancer Health Disparities
Conference Year: 2020
Abstract Body:
Purpose of the study: The primary goal of this study was to evaluate the association between
poverty as a measure of socioeconomic status and cancer survival in the Ohio cancer registry, Ohio
Cancer Incidence Surveillance System (OCISS).
Methods: OCISS collects information on all cancer diagnoses in the state of Ohio beginning in
1996. From this registry, we obtained demographic, clinical and outcome data on over a million
malignant cancer cases diagnosed from 1996-2016. Census tract level poverty was defined as the
percentage of individuals living below the poverty line based on the 2000 US census data, and
coded: <5%, 5-<10%, 10-<20%, and ≥20%. We used multivariable Cox proportional hazards
regression to calculate hazard ratios (HRs) and 95% confidence intervals (95% CI) for the
association between poverty and overall survival, adjusting for cancer site, age, race, sex, stage,
and primary treatment. We also evaluated the association with cause-specific mortality for prostate
(among men only) and bladder cancers.
Results: There were 717,945 (58%) deaths among the 1,232,154 cancer cases in OCISS. For all
sites and sexes combined, the association with overall survival between the highest and lowest
poverty categories was 1.25 (HR: 1.25; 95% CI: 1.24-1.26). Among men with prostate cancer
(n=157,497), increasing poverty index was associated with overall and prostate-cancer specific
survival (overall HR: 1.37, 95% CI: 1.33-1.41; prostate-cancer specific mortality HR: 1.43, 95% CI:
1.34-1.54). Among 32,531 cases of bladder cancer, we found similar associations; the highest
poverty category was associated with a 35% increased risk of overall mortality (HR: 1.35, 95% CI:
1.29-1.41) and a 32% increased risk of bladder-cancer specific mortality (HR: 1.32, 95% CI: 1.24-
1.41), compared with the lowest poverty category.
Conclusions: In Ohio, living in census tracts with higher levels of poverty was associated with both
overall and cancer-specific survival. Future analyses will incorporate more discrete categorizations
of socioeconomic status, including the area deprivation index and geospatial characteristics, and
will assess sex- and race-specific survival across these poverty and deprivation categories.
Keywords: State registry poverty cancer survival