Assessing the Burden of Cancer in Texas Using Vital Statistics Data

Cooper, Sharon P.; Sigurdson, Alice J.; Whitehead, Lawrence W.; Downs, T.; Burau, Keith D.; Vernon, Sally W.; Spitz, Margaret; New, Bonnie

doi:10.1097/00007611-199802000-00010

Cited by 5 publications

(9 citation statements)

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“…This excess also involved the North Metroplex and Upper East Texas PHRs, affecting both non-Hispanic white and black females, with the trend persisting between 1990 and 2001. Compared with the findings based on 1980 to 1990 data, 8 the excess mortality affecting black males might have ceased in 1996 because the excess mortality in this group was no longer statistically significant. On the other hand, the excess mortality detected among Hispanic males in the South and Lower South Texas PHRs reported by Cooper and colleagues 8 was found to have persisted between 1990 and 2001 at a moderate and statistically significant level (RR ϭ 1.21) in this study.…”

Section: Discussioncontrasting

confidence: 65%

“…Compared with the findings based on 1980 to 1990 data, 8 the excess mortality affecting black males might have ceased in 1996 because the excess mortality in this group was no longer statistically significant. On the other hand, the excess mortality detected among Hispanic males in the South and Lower South Texas PHRs reported by Cooper and colleagues 8 was found to have persisted between 1990 and 2001 at a moderate and statistically significant level (RR ϭ 1.21) in this study. Ongoing monitoring and preventive interventions are warranted to avoid the temporal trend of excess mortality from continuing.…”

Section: Discussioncontrasting

confidence: 65%

“…7 A study reported in the Southern Medical Journal indicated that between 1980 and 1990, colorectal cancer mortality in Texas increased at a statistically significant level, notably in African-American and Hispanic males. 8 In terms of geographic distribution of mortality, the (Dallas-Fort Worth) Metroplex, Gulf Coast, Central and Southwest Texas areas, namely the Public Health Regions, or PHR 3, 5, 6, and 7, had the highest age-adjusted mortality rates for colorectal cancer 9 (refer to figures for Public Health Regions). In addition, several Texas-specific cancer studies confirmed that cancer mortality has unevenly burdened residents in specific geographic regions over an extended period of time.…”

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confidence: 99%

“…In addition, several Texas-specific cancer studies confirmed that cancer mortality has unevenly burdened residents in specific geographic regions over an extended period of time. 10,11,12 Cooper and colleagues 8 reported that excess colorectal cancer mortality disproportionally affected certain racial and ethnic groups between 1980 and 1991. The affected regions included the Houston/Harris County area for non-Hispanic white men and women, and the Victoria Area for Hispanic men, all in PHR Region 6.…”

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confidence: 99%

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Surveillance of the Colorectal Cancer Disparities Among Demographic Subgroups: A Spatial Analysis

Hsu

Más²,

Hickey³

et al. 2006

Southern Medical Journal

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Objective: The literature suggests that colorectal cancer mortality in Texas is distributed inhomogeneously among specific demographic subgroups and in certain geographic regions over an extended period. To understand the extent of the demographic and geographic disparities, the present study examined colorectal cancer mortality in 15 demographic groups in Texas counties between 1990 and 2001. Methods:The Spatial Scan Statistic was used to assess the standardized mortality ratio, duration and age-adjusted rates of excess mortality, and their respective p-values for testing the null hypothesis of homogeneity of geographic and temporal distribution. Results:The study confirmed the excess mortality in some Texas counties found in the literature, identified 13 additional excess mortality regions, and found 4 health regions with persistent excess mortality involving several population subgroups. Conclusion:Health disparities of colorectal cancer mortality continue to exist in Texas demographic subpopulations. Health education and intervention programs should be directed to the at-risk subpopulations in the identified regions.Key Words: colorectal cancer, health disparities, public health informatics, Geographic Information Systems, spatial analysis. I n 2005, an estimated 56,290 deaths from colorectal cancer were expected in the United States, sustaining colorectal cancer as the third leading cause of cancer-related deaths among Americans.1 Recent studies suggest that screening is effective in decreasing colorectal cancer in both incidence and mortality by early detection and removal of precancerous lesions or polyps, and enhancing survival rates among colorectal cancer patients.2 Colorectal cancer is one of the most preventable types of cancer when detected at an early stage. However, while the 5-year survival rate for colorectal cancer is around 90% for those cases detected at an early stage, only about 37% of colorectal cancers were diagnosed at an early stage in 2004. 4 At the state level, between 1989 and 1998, the age-adjusted mortality rate for colorectal cancer in Texas actually increased by more than 20%.3 To target prevention and intervention efforts, it is important to understand the contributing risk factors for colorectal cancer affecting demographic groups living in different geographic regions. Key Points• Colorectal cancer mortality in Texas was found to be distributed inhomogeneously among specific demographic subgroups and in certain geographic regions over an extended period.• The study confirmed the excess mortality in some Texas counties reported in the literature, identified 13 additional excess mortality regions, and found 4 health regions with persistent excess mortality involving several population subgroups.• Health disparities in colorectal cancer mortality continue to exist in Texas demographic subpopulations.Health education and intervention programs should be enhanced to address the at-risk subpopulations in the identified regions.

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Section: Discussioncontrasting

confidence: 65%

Section: Discussioncontrasting

confidence: 65%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Surveillance of the Colorectal Cancer Disparities Among Demographic Subgroups: A Spatial Analysis

Hsu

Más²,

Hickey³

et al. 2006

Southern Medical Journal

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“…Texas-specific cancer research also indicated that Texas counties near the Gulf Coast, Bexar and El Paso counties, among others, had an excess mortality from cancers between 1980 and 1997. [3-5] On the other hand, the report of U.S. Cancer Statistics suggested that disparities exist in cancer mortality among different racial groups. [1] The report indicated that the occurrence of breast cancer among non-Hispanic White women was almost 1.2 times higher than that of Black women, and 1.7 times higher than that among Asians/Pacific Islanders.…”

Section: Introductionmentioning

confidence: 99%

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2004

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BackgroundThe literature suggests that the distribution of female breast cancer mortality demonstrates spatial concentration. There remains a lack of studies on how the mortality burden may impact racial groups across space and over time. The present study evaluated the geographic variations in breast cancer mortality in Texas females according to three predominant racial groups (non-Hispanic White, Black, and Hispanic females) over a twelve-year period. It sought to clarify whether the spatiotemporal trend might place an uneven burden on particular racial groups, and whether the excess trend has persisted into the current decade.MethodsThe Spatial Scan Statistic was employed to examine the geographic excess of breast cancer mortality by race in Texas counties between 1990 and 2001. The statistic was conducted with a scan window of a maximum of 90% of the study period and a spatial cluster size of 50% of the population at risk. The next scan was conducted with a purely spatial option to verify whether the excess mortality persisted further. Spatial queries were performed to locate the regions of excess mortality affecting multiple racial groups.ResultsThe first scan identified 4 regions with breast cancer mortality excess in both non-Hispanic White and Hispanic female populations. The most likely excess mortality with a relative risk of 1.12 (p = 0.001) occurred between 1990 and 1996 for non-Hispanic Whites, including 42 Texas counties along Gulf Coast and Central Texas. For Hispanics, West Texas with a relative risk of 1.18 was the most probable region of excess mortality (p = 0.001). Results of the second scan were identical to the first. This suggested that the excess mortality might not persist to the present decade. Spatial queries found that 3 counties in Southeast and 9 counties in Central Texas had excess mortality involving multiple racial groups.ConclusionSpatiotemporal variations in breast cancer mortality affected racial groups at varying levels. There was neither evidence of hot-spot clusters nor persistent spatiotemporal trends of excess mortality into the present decade. Non-Hispanic Whites in the Gulf Coast and Hispanics in West Texas carried the highest burden of mortality, as evidenced by spatial concentration and temporal persistence.

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Place of death of Houston area residents with cancer over a two-year period

Bruera

Sweeney

Russell

et al. 2003

Journal of Pain and Symptom Management

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The majority of cancer patients wish to die at home. Improved understanding of place of death and its relevant demographic predictors is important for the planning of palliative cancer care programs. The purpose of this study was to determine the place and predictors of site of death in cancer patients in a major U.S. metropolitan area. Death certificate data over two years were analyzed for Houston area residents with cancer who died in the Houston area. Information was obtained on factors that might be associated with the place where cancer patients die. For the purpose of this study, we looked at the following variables: primary site of cancer (hematological, breast, genitourinary, gastrointestinal, lung, and other); black, white, Hispanic, or Asian; age at death; marital status; sex; whether or not veteran of U.S. armed forces; levels of education; and area of residency within the Houston area. Univariate and multivariate analyses were performed. The majority of patients died in the hospital (51-52% both years), with the next most frequently occurring group dying at home (34-35% both years). Stepwise multivariate analysis resulted in a 6-variable logistic regression model. In this model, the odds of dying in hospital were increased by a factor of 2.7 if the patient had a hematological cancer (P<0.0001), a factor of 1.6 if the patient lived in Harris County (P<0.0001), and a factor of 1.5 if the patient was black (P<0.0001). Further characterization of factors associated with increased risk of hospital death rate is needed and systems should be developed to enable the majority of cancer patients to access palliative care services in the multiple settings in which they die.

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Assessing the Burden of Cancer in Texas Using Vital Statistics Data

Cited by 5 publications

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Surveillance of the Colorectal Cancer Disparities Among Demographic Subgroups: A Spatial Analysis

Surveillance of the Colorectal Cancer Disparities Among Demographic Subgroups: A Spatial Analysis

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Place of death of Houston area residents with cancer over a two-year period

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