Area-level Socioeconomic Disadvantage and Cancer Survival in Metropolitan Detroit

Snider, Natalie G; Hastert, Theresa A.; Nair, Mrudula; Kc, Madhav; Ruterbusch, Julie J.; Schwartz, Ann G.; Peters, Edward S.; Stoffel, Elena M.; Rozek, Laura S.; Purrington, Kristen

doi:10.1158/1055-9965.epi-22-0738

Cited by 9 publications

(15 citation statements)

References 66 publications

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“…However, we were unable to compare results with individual‐level education due to unavailable information in the SEER program. Another study, using the area deprivation index (ADI) (education is one of the indicators), found that increasing ADI was associated with a 1.1‐fold increased risk of CRC mortality in Black patients 17 . Therefore, these previous studies demonstrate that racial minorities and lower SES are more likely to experience poorer survival outcomes, which is consistent with our findings.…”

Section: Discussionsupporting

confidence: 90%

“…area deprivation index (ADI) (education is one of the indicators), found that increasing ADI was associated with a 1.1-fold increased risk of CRC mortality in Black patients. 17 Therefore, these previous studies demonstrate that racial minorities and lower SES are more likely to experience poorer survival outcomes, which is consistent with our findings. SES and racial disparities can in part explain CRC patient inequalities in access to early detection, suitable and appropriate quality care, and survival.…”

Section: Model 1 Csupporting

confidence: 92%

“…Third, we selected the higher burden regions of CRC mortality using Georgia public health districts, which may have the potential for including more specific race groups in the study; however, the overall racial composition in Georgia is 50% White and 33% Black with an increasing Hispanic/Latino population. Finally, although our study used traditional survival analyses which have been used in prior studies regarding analysis of CRC survival, 17,39 it may have potential bias due to non-CRC or non-cancer deaths. More research using alternative modeling approaches may further elucidate this relationship.…”

Section: Model 1 Cmentioning

confidence: 99%

“…Although a few studies examining racial disparities in CRC survival considered neighborhood SES, they primarily focused on large geographic areas by using a composite index. 16,17 The influence of specific SES at a regional level on CRC survival in smaller geographic areas is not well understood, particularly the comparison of different racial groups. A study of CRC survival profiles considering area-level SES within small areas is essential to inform local policies for allocating appropriate health resources.…”

Section: Introductionmentioning

confidence: 99%

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Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia

Tsai,

Vernon,

et al. 2024

Cancer Medicine

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IntroductionThe study's purpose was to examine 5‐year colorectal cancer (CRC) survival rates between White and Black patients. We also determined whether regional socioeconomic status (SES) is associated with CRC survival between White and Black patients in the Clayton, West Central, East Central, Southeast, and Northeast Georgia public health districts.MethodsWe performed a retrospective cohort analysis using data from the 1975 to 2016 Surveillance, Epidemiology, and End Results program. The 2015 United States Department of Agriculture Economic Research Services county typology codes were used to identify region‐level SES with persistent poverty, low employment, and low education. Kaplan–Meier method and Cox proportional hazard regression were performed.ResultsAmong 10,876 CRC patients (31.1% Black patients), 5‐year CRC survival rates were lower among Black patients compared to White patients (65.4% vs. 69.9%; p < 0.001). In multivariable analysis, White patients living in regions with persistent poverty had a 1.1‐fold increased risk of CRC death (HR, 1.12; 95% CI, 1.00–1.25) compared to those living in non‐persistent poverty regions. Among Black patients, those living in regions with low education were at a 1.2‐fold increased risk of CRC death (HR, 1.19; 95% CI, 1.01–1.40) compared to those living in non‐low education regions.Discussion and ConclusionsBlack patients demonstrated lower CRC survival rates in Georgia compared to their White counterparts. White patients living in regions with persistent poverty, and Black patients living in regions with low education had an increased risk of CRC death. Our findings provide important evidence to all relevant stakeholders in allocating health resources aimed at CRC early detection and prevention and timely referral for CRC treatment by considering the patient's regional SES in Georgia.

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Section: Discussionsupporting

confidence: 90%

Section: Model 1 Csupporting

confidence: 92%

Section: Model 1 Cmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia

Tsai,

Vernon,

et al. 2024

Cancer Medicine

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“…In another study, 15 neighborhood deprivation was associated with increased breast cancer mortality among White women, but a nonsignificant decrease was found among Black women. Nevertheless, other studies have reported no effect measure modification by race, with neighborhood deprivation increasing breast cancer mortality among both Black and White women, [11][12][13] or having no impact in either group. 16 The present study is, to our knowledge, the first attempt to uncover potential race-specific heterogeneity in the association between neighborhood deprivation and breast cancer mortality by investigating multiple stratifying factors representing access to health care, social cohesion, and residential racial segregation.…”

Section: Discussionmentioning

confidence: 90%

Neighborhood Deprivation and Breast Cancer Mortality Among Black and White Women

Barber,

Maliniak,

Moubadder

et al. 2024

JAMA Netw Open

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ImportanceNeighborhood deprivation has been associated with increased breast cancer mortality among White women, but findings are inconsistent among Black women, who experience different neighborhood contexts. Accounting for interactions among neighborhood deprivation, race, and other neighborhood characteristics may enhance understanding of the association.ObjectiveTo investigate whether neighborhood deprivation is associated with breast cancer mortality among Black and White women and whether interactions with rurality, residential mobility, and racial composition, which are markers of access, social cohesion, and segregation, respectively, modify the association.Design, Setting, and ParticipantsThis population-based cohort study used Georgia Cancer Registry (GCR) data on women with breast cancer diagnosed in 2010 to 2017 and followed-up until December 31, 2022. Data were analyzed between January 2023 and October 2023. The study included non-Hispanic Black and White women with invasive early-stage (I-IIIA) breast cancer diagnosed between 2010 and 2017 and identified through the GCR.ExposuresThe Neighborhood Deprivation Index (NDI), assessed in quintiles, was derived through principal component analysis of 2011 to 2015 block group–level American Community Survey (ACS) data. Rurality, neighborhood residential mobility, and racial composition were measured using Georgia Public Health Department or ACS data.Main Outcomes and MeasuresThe primary outcome was breast cancer–specific mortality identified by the GCR through linkage to the Georgia vital statistics registry and National Death Index. Cox proportional hazards regression was used to estimate age-adjusted and multivariable-adjusted hazard ratios (HRs) and 95% CIs for the association between neighborhood deprivation and breast cancer mortality.ResultsAmong the 36 795 patients with breast cancer (mean [SD] age at diagnosis, 60.3 [13.1] years), 11 044 (30.0%) were non-Hispanic Black, and 25 751 (70.0%) were non-Hispanic White. During follow-up, 2942 breast cancer deaths occurred (1214 [41.3%] non-Hispanic Black women; 1728 [58.7%] non-Hispanic White women). NDI was associated with an increase in breast cancer mortality (quintile 5 vs 1, HR, 1.36; 95% CI, 1.19-1.55) in Cox proportional hazards models. The association was present only among non-Hispanic White women (quintile 5 vs 1, HR, 1.47; 95% CI, 1.21-1.79). Similar race-specific patterns were observed in jointly stratified analyses, such that NDI was associated with increased breast cancer mortality among non-Hispanic White women, but not non-Hispanic Black women, irrespective of the additional neighborhood characteristics considered.Conclusions and RelevanceIn this cohort study, neighborhood deprivation was associated with increased breast cancer mortality among non-Hispanic White women. Neighborhood racial composition, residential mobility, and rurality did not explain the lack of association among non-Hispanic Black women, suggesting that factors beyond those explored here may contribute to breast cancer mortality in this racial group.

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Neighborhood Disadvantage and Prostate Tumor RNA Expression of Stress-Related Genes

Boyle,

Yau,

Slade

et al. 2024

JAMA Netw Open

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ImportanceAfrican American men experience greater prostate cancer incidence and mortality than White men. Growing literature supports associations of neighborhood disadvantage, which disproportionately affects African American men, with aggressive prostate cancer; chronic stress and downstream biological impacts (eg, increased inflammation) may contribute to these associations.ObjectiveTo examine whether several neighborhood disadvantage metrics are associated with prostate tumor RNA expression of stress-related genes.Design, Setting, and ParticipantsThis cross-sectional study leveraged prostate tumor transcriptomic data for African American and White men with prostate cancer who received radical prostatectomy at the University of Maryland Medical Center between August 1992 and January 2021. Data were analyzed from May 2023 to April 2024.ExposuresUsing addresses at diagnosis, 2 neighborhood deprivation metrics (Area Deprivation Index [ADI] and validated bayesian Neighborhood Deprivation Index) as well as the Racial Isolation Index (RI) and historical redlining were applied to participants’ addresses. Self-reported race was determined using electronic medical records.Main Outcomes and MeasuresA total of 105 stress-related genes were evaluated with each neighborhood metric using linear regression, adjusting for race, age, and year of surgery. Genes in the Conserved Transcriptional Response to Adversity (CTRA) and stress-related signaling genes were included.ResultsA total of 218 men (168 [77%] African American, 50 [23%] White) with a median (IQR) age of 58 (53-63) years were included. African American participants experienced greater neighborhood disadvantage than White participants (median [IQR] ADI, 115 [100-130] vs 92 [83-104]; median [IQR] RI, 0.68 [0.34-0.87] vs 0.11 [0.06-0.14]). ADI was positively associated with expression for 11 genes; HTR6 (serotonin pathway) remained significant after multiple-comparison adjustment (β = 0.003; SE, 0.001; P &lt; .001; Benjamini-Hochberg q value = .01). Several genes, including HTR6, were associated with multiple metrics. We observed higher expression of 5 proinflammatory genes in the CTRA with greater neighborhood disadvantage (eg, CXCL8 and ADI, β = 0.008; SE, 0.003; P = .01; q value = .21).Conclusions and RelevanceIn this cross-sectional study, the expression of several stress-related genes in prostate tumors was higher among men residing in disadvantaged neighborhoods. This study is one of the first to suggest associations of neighborhood disadvantage with prostate tumor RNA expression. Additional research is needed in larger studies to replicate findings and further investigate interrelationships of neighborhood factors, tumor biology, and aggressive prostate cancer to inform interventions to reduce disparities.

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Area-level Socioeconomic Disadvantage and Cancer Survival in Metropolitan Detroit

Cited by 9 publications

References 66 publications

Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia

Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia

Neighborhood Deprivation and Breast Cancer Mortality Among Black and White Women

Neighborhood Disadvantage and Prostate Tumor RNA Expression of Stress-Related Genes

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