Residential racial and economic segregation across US counties is associated with higher cancer mortality, according to research published in JAMA Oncology.
Researchers found that counties with the greatest degree of deprivation had higher mortality for all cancers combined and across 12 of 13 cancers assessed individually.
For this study, the researchers evaluated data from the US Census Bureau and the National Center for Health Statistics from 2015 through 2019. The team examined the association between residential segregation and mortality for 13 cancer types that represent the top 10 causes of cancer deaths in men and women.
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There were 3110 counties evaluated. Residential segregation within counties was measured using the Index of Concentration at the Extremes (ICE). This index is computed using a calculation that takes into consideration the number of White persons who have above the 80th percentile of household income and the number of Black persons who have below the 20th percentile of household income.
Counties were categorized into quintiles based on ICE scores, with the first quintile corresponding to the greatest degree of deprivation and the fifth quintile corresponding to the least deprivation.
When the researchers examined all cancers combined, they found the age-adjusted cancer mortality rate was highest in the first quintile and lowest in the fifth quintile. Per 100,000 persons, these rates were 179.81 for the first quintile, 177.28 for the second quintile, 167.57 for the third quintile, 159.62 for the fourth quintile, and 146.14 for the fifth quintile (P <.001).
For all cancers, adjusted cancer mortality rate ratios were increased for the first 4 quintiles compared with the fifth quintile, which was the reference. This reflects higher all-cancer mortality in quintiles associated with greater deprivation (P <.001).
The first quintile had significantly higher adjusted cancer mortality rate ratios, compared with the fifth quintile, for 12 of the 13 cancer types, as seen in the table below.
|
Adjusted Cancer Mortality Rate Ratio by Quintile and Cancer Type |
|||||
|
Quintile 1 |
Quintile 2 |
Quintile 3 |
Quintile 4 |
P for trend |
|
|
All cancers |
1.22 |
1.17 |
1.10 |
1.06 |
<.001 |
|
Lung and bronchus |
1.49 |
1.36 |
1.20 |
1.10 |
<.001 |
|
Colon and rectum |
1.23 |
1.16 |
1.09 |
1.07 |
<.001 |
|
Pancreas |
1.14 |
1.06 |
1.04 |
1.05 |
<.001 |
|
Liver and Intrahepatic bile duct |
1.12 |
1.13 |
1.06 |
1.04 |
<.001 |
|
Leukemia |
1.16 |
1.09 |
1.05 |
1.04 |
<.001 |
|
Esophagus |
1.19 |
1.11 |
1.07 |
1.08 |
<.001 |
|
Urinary bladder |
1.15 |
1.13 |
1.08 |
1.04 |
<.001 |
|
Non-Hodgkin lymphoma |
1.11 |
1.09 |
1.07 |
1.06 |
<.001 |
|
Brain and other nervous system |
1.06 |
1.02 |
0.99 |
1.00 |
.008 |
|
Prostate |
1.12 |
1.02 |
1.02 |
1.01 |
<.001 |
|
Breast |
1.15 |
1.09 |
1.06 |
1.03 |
<.001 |
|
Ovary |
1.00 |
1.01 |
1.00 |
0.99 |
.688 |
|
Uterine corpus |
1.14 |
1.06 |
1.02 |
1.04 |
.001 |
“Taken together with previous evidence, the findings of this ecological study suggest that residential segregation incorporating both race and income polarization is associated with increased cancer mortality at the county level, highlighting opportunities for geographically targeted cancer prevention and control efforts,” the researchers concluded.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Zhang L, Gong R, Shi L, et al. Association of residential racial and economic segregation with cancer mortality in the US. JAMA Oncol. Published online November 17, 2022. doi:10.1001/jamaoncol.2022.5382.
This article originally appeared on Cancer Therapy Advisor
