Disparities in Cancer Mortality and Incidence Among American Indians and Alaska Natives in the United States

White, Mary C.; Espey, David K.; Swan, Judith; Wiggins, Charles L.; Eheman, Christie R.; Kaur, Judith S.

doi:10.2105/ajph.2013.301673

Cited by 170 publications

(154 citation statements)

References 36 publications

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“…66 AI/ANs have the highest rates of kidney cancer, although there is striking geographic variation, most likely reflecting differences in the prevalence of renal cancer risk factors such as obesity, smoking, and hypertension. 67 …”

mentioning

confidence: 99%

Cancer statistics, 2017

Siegel

Miller

Jemal

2017

CA A Cancer J Clinicians

14,175

10,469

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, 1,688,780 new cancer cases and 600,920 cancer deaths are projected to occur in the United States. For all sites combined, the cancer incidence rate is 20% higher in men than in women, while the cancer death rate is 40% higher. However, sex disparities vary by cancer type. For example, thyroid cancer incidence rates are 3-fold higher in women than in men (21 vs 7 per 100,000 population), despite equivalent death rates (0.5 per 100,000 population), largely reflecting sex differences in the "epidemic of diagnosis." Over the past decade of available data, the overall cancer incidence rate (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) was stable in women and declined by approximately 2% annually in men, while the cancer death rate (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) declined by about 1.5% annually in both men and women. From 1991 to 2014, the overall cancer death rate dropped 25%, translating to approximately 2,143,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the cancer death rate was 15% higher in blacks than in whites in 2014, increasing access to care as a result of the Patient Protection and Affordable Care Act may expedite the narrowing racial gap; from 2010 to 2015, the proportion of blacks who were uninsured halved, from 21% to 11%, as it did for Hispanics (31% to 16%). Gains in coverage for traditionally underserved Americans will facilitate the broader application of existing cancer control knowledge across every segment of the population. CA Cancer J Clin 2017;67:7-30.

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mentioning

confidence: 99%

Cancer statistics, 2017

Siegel

Miller

Jemal

2017

CA A Cancer J Clinicians

14,175

10,469

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“…IHSCS is a system of clinics that provide primary care services to AI/ANs, and is restricted to members of federally-recognized tribes for some states. NHWs were chosen as the comparison group, consistent with literature standards (8, 18). We included individuals who were: 1) diagnosed between 2001 and 2007 with SEER “distant” stage cancer (AJCC stage IV: Tx Nx M1) of the breast (female only), colorectum, lung, prostate, ovary, or stomach, 2) age 65 or older, 3) residing in a SEER catchment area, 4) enrolled in Medicare parts A and B ≥1 month prior to diagnosis, and 5) AI/AN or NHW.…”

Section: Methodsmentioning

confidence: 99%

Cancer-Directed Therapy and Hospice Care for Metastatic Cancer in American Indians and Alaska Natives

Shiovitz

Bansal

Burnett‐Hartman

et al. 2015

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background Little has been reported regarding patterns of oncologic care in American Indian/Alaska Natives (AI/ANs). Observed worse survival has been attributed to later-stage presentation. We aimed to evaluate racial differences in cancer-directed therapy and hospice care utilization in AI/ANs and non-Hispanic Whites (NHWs) with metastatic cancer. Methods The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims database was accessed for AI/AN and NHW metastatic-cancer cases diagnosed 2001–2007. Utilization of cancer-directed therapy (surgery, radiation, and/or chemotherapy) and/or hospice services were compared between AI/ANs and NHWs. Minimally-adjusted (age, sex, diagnosis year) and fully-adjusted (also Klabunde comorbidity score, sociodemographic factors) regression models were used to estimate odds (ORs) and hazard ratios (HRs) for receipt of care. Results AI/ANs were younger, more likely to reside in the West, be unmarried, have lower income, and live in a non-urban setting than NHWs. Fewer AI/ANs received any cancer-directed therapy (57% vs. 61% NHWs) within 3 months of diagnosis; sociodemographic factors accounted for much of this difference (fully-adjusted HR 0.94, 95% confidence interval(CI) 0.83–1.08). We noted differences in hospice utilization between AI/ANs (52%) and NHWs (61%). A significant difference in hospice utilization remained after adjustment for sociodemographics (OR 0.78, 95%CI: 0.61–0.99). Conclusion Observed absolute differences in care for AI/ANs and NHWs with metastatic cancer were largely accounted for by adjusting for socioeconomics, comorbidities, and demographic factors. A significant association between race and hospice utilization was noted. Impact Efforts to improve metastatic-cancer care should focus on socioeconomic barriers and investigate the observed disparity in receipt of hospice services.

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“…Indigenous groups present with more advanced-stage cancers and have higher rates of cancer mortality when compared with non-indigenous people in the same country [4e6]. Indeed, cancer is the leading cause of premature death among the American Inuit [25]. They are the only racial group in the USA for which cancer death rates have not declined over the past 20 years; instead, cancer mortality rates have increased [25].…”

Section: 'Global Health' Needed Within Highincome Countriesmentioning

confidence: 99%

“…Indeed, cancer is the leading cause of premature death among the American Inuit [25]. They are the only racial group in the USA for which cancer death rates have not declined over the past 20 years; instead, cancer mortality rates have increased [25]. As global oncology works in parallel to address LMICs and these vulnerable communities within HICs, we hope there will be many opportunities for solution sharing and mutual benefit.…”

Section: 'Global Health' Needed Within Highincome Countriesmentioning

confidence: 99%

Mobilising Expertise and Resources to Close the Radiotherapy Gap in Cancer Care

et al. 2017

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Closing the gap in cancer care within low-and middle-income countries and in indigenous and geographically isolated populations in high-income countries requires investment and innovation. This is particularly true for radiotherapy, for which the global disparity is one of the largest in healthcare today. New models and paradigms and non-traditional collaborations have been proposed to improve global equity in cancer control. We describe recent initiatives from within the radiation oncology community to increase access to treatment, build the low-and middle-income countries' radiation oncology workforce, mobilise more professionals from within high-income countries and raise awareness of the global need for equitable cancer care.

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Disparities in Cancer Mortality and Incidence Among American Indians and Alaska Natives in the United States

Abstract: Spatial variations in mortality and incidence by type of cancer demonstrated both persistent and emerging challenges for cancer control in AI/AN populations.

Cited by 170 publications

References 36 publications

Cancer statistics, 2017

Cancer statistics, 2017

Cancer-Directed Therapy and Hospice Care for Metastatic Cancer in American Indians and Alaska Natives

Mobilising Expertise and Resources to Close the Radiotherapy Gap in Cancer Care

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