Socioeconomic Factors and Cancer Incidence Among Blacks and Whites

Abstract

Findings from previous studies suggest that differences in socioeconomic status may be responsible for some, if not all, of the elevated incidence of cancer among blacks as compared with whites. Using incidence data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, we tested this hypothesis by correlating black and white cancer incidence rates in three US metropolitan areas between 1978 and 1982 with data from the 1980 census on socioeconomic status within individual census tracts. The study analyzed data on the incidence of cancer at all sites combined (greater than 100 cancer sites) and at seven major sites separately. As in other studies, income and educational levels served as surrogates for socioeconomic status. The present study also used census-tract data on population density as a surrogate factor. Each of these measures of socioeconomic status was analyzed independently. Before correlation with census-tract data, age-adjusted data on cancer incidence showed statistically significant elevated risks among blacks for cancer at all sites combined and at four of the seven separate sites; whites showed an elevated risk for cancer at two sites. Cancer at only one site, the colon, showed no significant association with race. When age-adjusted incidence data were correlated with socioeconomic status, the comparative black-white risks changed: Whites showed an elevated risk of cancer at all sites combined and at three of the seven separate sites; blacks maintained their elevated risk at three sites. These findings suggest that the disproportionate distribution of blacks at lower socioeconomic levels accounts for much of the excess cancer burden among blacks. They also suggest that for both blacks and whites unidentified racial factors, which may be either cultural or genetic and which are not closely linked to socioeconomic status, may play a role in the incidence of some cancers.

A Multilevel Analysis of Socioeconomic Status and Prostate Cancer Risk

“…Again, the reduction in risk was stronger for men with a diagnosis of localized disease than those with a diagnosis of advanced disease. The negative association we found was in contrast to most previous studies of area-level SES and prostate cancer that reported a positive association (5-7) or no association (8)(9)(10). In their study of area-level SES and prostate cancer mortality using the American Cancer Society Nutrition Cohort Study, Steenland et al (K. Steenland, personal communication, February 9, 2006) found a positive association.…”

“…Two of the four studies that evaluated the association between individual-level SES and prostate cancer incidence in the United States reported positive associations (1,2), whereas two studies reported no association (3,4). Of the seven studies that investigated area-level SES and prostate cancer incidence in the United States, three studies each reported a positive association (5)(6)(7) or no association (8)(9)(10), whereas one study reported a negative association (11). Proposed mechanisms for explaining the positive association between individual-level and area-level SES and prostate cancer are consuming a healthy diet (4), engaging in exercise (4), and increased access to screening (12).…”

Socioeconomic status and colon cancer incidence: a prospective cohort study

“…The association between education and colon cancer risk is not clear for women. A correlation study (Baquet et al, 1991), a cross-sectional study (Faivre et al, 1989) and a case-control study (Bidoli et al, 1992) reported no association between education and colon cancer risk for women, while an inverse association was found in a crosssectional study (Williams and Horm, 1977), and in two cohort studies in Scandinavia (Pukkala and Teppo, 1986;Vagero and Persson, 1986) significant positive associations were reported. We did not find an association between education and colon cancer, which is consistent with the finding that health differences between SES categories for women are Kunst et al, 1993), probably because of relatively small differences in education within the female population.…”

“…Correlation (Baquet et al, 1991) and crosssectional (Williams and Horm, 1977;Faivre et al, 1989) studies did not show consistent associations, but case-control (Papadimitriou et al, 1984;Ferraroni et al, 1989;Bidoli et al, 1992) and cohort studies (Pukkala and Teppo, 1986;Vagero and Persson, 1986;Leon, 1988) showed predominantly positive associations between SES and colon cancer risk. In these studies hardly any adjustment was made for potential confounders.…”

Health Literacy and Cancer Communication

“…20 Adults with lower socioeconomic status (SES) and older age are less likely to be screened for cancer, more likely to have advanced cancer at presentation, and suffer disproportionately high levels of cancer mortality. [21][22][23][24][25][26][27][28] Low literacy, which correlates with both low SES and older age, is an under-appreciated factor in cancer control communication and patient decisionmaking. 11,27,[29][30][31] Individuals with low health literacy obtain less information from cancer control messages, materials, and conversations.…”