ASPO Abstracts
Association of residential economic and racial segregation with mortality in the U.S.
Category: Cancer Health Disparities
Conference Year: 2022
Abstract Body:
Purpose: To examine the association of residential economic and racial segregation with the mortality from any causes, top 10 causes, and top 5 male and female cancer sites in the U.S.Methods: Using the 2019 American Community Survey 5-year estimate data, county-level residential economic and racial segregation was measured by the Index of Concentration at the Extremes (ICE), showing the extent to which an area's residents are concentrated in extremes of deprivation and privilege. ICE values were categorized into quintiles. Age-adjusted mortality data (2015-2019) were obtained from the National Center for Health Statistics. Counties with Rural-Urban Continuum Codes (RUCC) 1-3 were categorized as metropolitan areas and others as non-metropolitan areas. Adjusted rate ratios (ARRs) and 95% confidence intervals (CIs) for the association between ICE and mortality were calculated using multilevel mixed modeling clustered at the state level, weighted by county population size, and adjusted for metropolitan status, median income, and the proportion of the population with non-White race. Data of 3,317 counties were extracted.Results: Age-adjusted all-cause death rates in the five quintiles of ICE were 927.2 (most deprived), 898.2, 823.8, 770.0, 686.8 (most privileged), per 100,000 persons per year, respectively (P-for-trend<0.0001). Compared to the most privileged group, ARRs for all-cause mortality were 1.12 (95% CI: 1.10-1.15), 1.11 (1.09-1.13), 1.05 (1.03-1.17), and 1.01 (0.99-1.03), respectively. Age-adjusted cancer death rates for the five quintiles were 179.6, 177.4, 167.4, 159.8, and 146.1, per 100,000 persons per year, respectively (P-for-trend<0.0001). ARRs for cancer mortality were 1.13 (1.10-1.16), 1.10 (1.08-1.12), 1.05 (1.03-1.07), and 1.02 (1.01-1.04), respectively. ICE was also strongly associated with mortality from heart disease, chronic lower respiratory diseases, stroke, Alzheimer's disease, kidney disease, influenza and pneumonia, as well as cancers of the lung, female breast, colorectum, and pancreas.Conclusions: County-level segregation is significantly associated with all-cause mortality and mortality from major diseases including cancer.
Keywords: residential economic and racial segregation, mortality, county