Persistent Poverty and Cancer Mortality Rates: An Analysis of County-Level Poverty Designations

Abstract

Background: Cancer mortality is higher in counties with high levels of (current) poverty, but less is known about associations with persistent poverty. Persistent poverty counties (with ≥20% of residents in poverty since 1980) face social, structural, and behavioral challenges that may make their residents more vulnerable to cancer. Methods: We calculated 2007 to 2011 county-level, age-adjusted, and overall and type-specific cancer mortality rates (deaths/100,000 people/year) by persistent poverty classifications, which we contrasted with mortality in counties experiencing current poverty (≥20% of residents in poverty according to 2007–2011 American Community Survey). We used two-sample t tests and multivariate linear regression to assess mortality by persistent poverty, and compared mortality rates across current and persistent poverty levels. Results: Overall cancer mortality was 179.3 [standard error (SE) = 0.55] deaths/100,000 people/year in nonpersistent poverty counties and 201.3 (SE = 1.80) in persistent poverty counties (12.3% higher, P < 0.0001). In multivariate analysis, cancer mortality was higher in persistent poverty versus nonpersistent poverty counties for overall cancer mortality as well as for several type-specific mortality rates: lung and bronchus, colorectal, stomach, and liver and intrahepatic bile duct (all P < 0.05). Among counties experiencing current poverty, those counties that were also experiencing persistent poverty had elevated mortality rates for all cancer types as well as lung and bronchus, colorectal, breast, stomach, and liver and intrahepatic bile duct (all P < 0.05). Conclusions: Cancer mortality was higher in persistent poverty counties than other counties, including those experiencing current poverty. Impact: Etiologic research and interventions, including policies, are needed to address multilevel determinants of cancer disparities in persistent poverty counties.

Renal Cell Carcinoma Health Disparities in Stage and Mortality among American Indians/Alaska Natives and Hispanic Americans: Comparison of National Cancer Database and Arizona Cancer Registry Data

“…The effects of neighborhood socioeconomic factors on mortality have been investigated for many cancer types [ 18 , 45 , 46 , 47 ]. Census-tract high school education, median household income, unemployment, and poverty rates are often used to assess associations between neighborhood characteristics and cancer outcomes.…”

“…An emerging literature on structural inequality and neighborhood characteristics, such as redlining and segregation, have also been implicated in impacting cancer outcomes [ 19 , 20 , 21 ] strengthening the need to integrate census-tract level data to better understand patterns of cancer disparities. For example, the dominant role of poverty in cancer disparities is well-established [ 18 , 19 , 48 ]. Individuals living in neighborhoods with persistent poverty, defined as ≥20% of resident in poverty since 1980, face multiple challenges and have an increased cancer mortality risk [ 18 ].…”

“…Previous kidney cancer studies had limited geographic scope in their analyses or focused primarily on epidemiological data without an in-depth analysis of the complex dimensions of socioeconomic and geographic factors that may be driving kidney cancer disparities [ 5 , 6 , 15 , 16 , 17 ]. The cancer disparities literature has broadly established the role of structural determinants of cancer outcomes, such as persistent poverty [ 18 ] and neighborhood effects [ 19 ]. The intersection of structural barriers and neighborhood characteristics in the form of redlining [ 20 ] and segregation [ 19 , 21 ] has begun to emerge as a salient consideration of cancer outcomes across the cancer continuum.…”

Black, Hispanic patients with cancer at greater risk for COVID‐19

“…DOI: 10.1002/cncr.33512 R esidents in US counties with persistent poverty rates have a high risk of cancer mortality, according to a study published in Cancer Epidemiology, Biomarkers & Prevention. 1 Study researchers found the overall cancer mortality rate in persistent-poverty counties was 201.3 deaths per 100,000 people versus 179.3 deaths per 100,000 people in counties without persistent poverty. In every cancer type studied, mortality rates were between 11% and 50% higher in persistent-poverty counties than in counties without persistent poverty.…”

Persistent poverty rates linked to higher cancer mortality rates

“…Residents in US counties with persistent poverty rates have a high risk of cancer mortality, according to a study published in Cancer Epidemiology, Biomarkers & Prevention 1 …”