Researchers at Yale University have found that county-wide cancer death rates vary substantially according to income, owing largely to factors related to socioeconomic status, health care, lifestyle, and government policies. This knowledge could be used to target the causes of the disparity in the hopes of reducing cancer deaths in lower-income areas.
The cross-sectional study analyzed data from 3,135 US counties whose cancer death rates from the year 2014 were made available in a database published by the Institute for Health Metrics and Evaluation. Higher income counties, which had a median income of $55,780, had an average of 185.9 deaths per 100,000, compared with 204.9 in medium-income ($43,010) counties and 229.7 in low-income ($33,445) counties. A combination of factors accounted for over 80% of the income-related disparity, including health risk behaviors such as smoking, obesity, and physical activity; health care factors such as unaffordable or low-quality care; food insecurity; and health policies such as state smoke-free laws and Medicaid payment rates.
The factors contributing the most to the disparity were food insecurity, which accounted for 19.1% of the association, followed by low-quality health care (17.9%), smoking (12.7%), and physical inactivity (12.2%). "All of these factors are interplaying to lead to disparities," stated the study's first author, Jeremy O'Connor, MD, who conducted the research as a National Clinician Scholar at Yale School of Medicine. "It's not just health behaviors or quality of care; it's all of the factors together."
In their paper, published in JAMA Network Open, the authors note that there are a variety of ways in which the 2 leading factors, food insecurity and low-quality health care, could be contributing to the increased cancer deaths: "For example, low-quality clinical care may lead to delays in the diagnosis and treatment of cancer, and food insecurity may increase the incidence of certain cancers in populations due to poor nutrition, even if obesity rates are similar. Efforts to target nonbehavioral mediators might be useful in light of evidence that addressing health risk behaviors is necessary but not sufficient if the ultimate goal is to eliminate health disparities."
The study authors emphasize the importance of utilizing this information: "Because of the unacceptable gaps in cancer outcomes across counties that persist despite major advances in cancer care, there is an urgent need for actions to determine whether targeting these factors might ameliorate disparities."
For More Information
O'Connor JM, Sedghi T, Dhodapkar M, et al (2018). Factors associated with cancer disparities among low-, medium-, and high-income US counties. JAMA Network Open, 1(6):e183146. DOI:10.1001/jamanetworkopen.2018.3146