Using a Socioeconomic Position Index to Assess Disparities in Cancer Incidence and Mortality, Puerto Rico, 1995-2004

Abstract

Introduction Evaluation of the extent of socioeconomic inequalities in cancer incidence and mortality is essential to generate hypotheses in population health research and provides evidence for population-based strategies for comprehensive cancer control. The objective of this study was to create an area-based socioeconomic position (SEP) index to assess possible socioeconomic disparities in incidence and mortality of selected cancers in Puerto Rico. Methods Data for cancer incidence and mortality from 1995 to 2004 were obtained from the Puerto Rico Central Cancer Registry and the Puerto Rico Department of Health, and Puerto Rico socioeconomic data were obtained from the US Census 2000. We used principal component and factor analysis methods to construct the SEP index at the municipality level. We calculated age-adjusted incidence and mortality for each SEP area and used rate ratios to evaluate the differences by SEP. Results Incidence and mortality of cancer in Puerto Rico varied by SEP area. In general, the incidence and mortality for cancers of the esophagus and stomach were higher for municipalities with the lowest SEP; in contrast, rates for breast, colorectal, kidney, pancreas, prostate, and thyroid were higher for areas with the highest SEP. Conclusion These results highlight cancer disparities in Puerto Rico by SEP level that warrant further research.

Impact of Enhanced Detection on the Increase in Thyroid Cancer Incidence in the United States: Review of Incidence Trends by Socioeconomic Status Within the Surveillance, Epidemiology, and End Results Registry, 1980–2008

“…However, this registry provides the largest nationwide data from a population-based cancer registry, and the results we report still provide evidence of the impact of enhanced detection on the increase in thyroid cancer incidence and lead to further investigation and discussion. Our findings are in agreement with other studies that have suggested that higher SES is associated with higher thyroid cancer incidence (18)(19)(20). Morris et al reported a lower incidence of thyroid cancer diagnosis among individuals residing in poorer versus wealthier zip code areas (18).…”

“…Therefore, if the observed increase in thyroid cancer is due to enhanced detection, patients with higher SES, who generally have better access to health care-including diagnostic tests-would be expected to have a greater increase in thyroid cancer incidence than patients with lower SES. Several studies have indicated that higher SES is indeed associated with higher thyroid cancer incidence (18)(19)(20), but there is limited understanding of changing trends in thyroid cancer incidence over time by SES or how tumor size might factor into these associations. In an effort to elucidate the contribution of enhanced detection to the recent increases in thyroid cancer incidence, we compared thyroid cancer incidence trends between low-and high-SES counties in the United States over the past three decades.…”

Relationship between quality of life and clinical status in patients with gastrointestinal cancer

“…The difference in tumor location between socioeconomic groups (gastric cancer is more common in lower classes, whereas colorectal cancer is more common in upper classes) has been noted in previous studies conducted in Latin American populations (31). Although average patient age was rather low in both groups evaluated in the present study, previous studies in Latin America have reported similar results, especially for gastric cancer (32).…”

Cancer Incidence Rate in the Elderly Inhabitants of Tehran: Is there Really any Cluster?

“…Also, it may be proposed that prostate-specific antigen testing (PSA) is responsible for an increase in low-grade prostate cancer in advantaged men, but it does not explain the overall increases in all grades as 37% lower inci- dence was revealed among the most disadvantaged compared to the most advantaged (35). Although higher levels of SES were significantly associated with an increased risk of prostate cancer (36,37), no evidence was found on the racially uniform population of Caucasians who received free health care (38).…”