Socioeconomic Inequalities in Cancer Incidence and Mortality

Socioeconomic and Racial/Ethnic Disparities in Cancer Mortality, Incidence, and Survival in the United States, 1950–2014: Over Six Decades of Changing Patterns and Widening Inequalities

“…Studies have shown the dynamic nature of socioeconomic disparities in cancer rates as the association between SES and incidence and mortality from major cancers has changed markedly during the past 5 decades [4–7]. Temporal patterns have changed largely as a result of differential rates of decline or increase in mortality among those in various socioeconomic groups and changing sociodemographic patterns in major cancer risk factors such as smoking, diet, obesity, and physical inactivity [3–6].…”

“…Contemporary data indicate lower rates of lung, stomach, liver, cervical, esophageal, and oropharyngeal cancer and higher rates of breast cancer and melanoma at higher SES levels [3–18]. The major behavioral determinants of cancer, such as smoking, diet, alcohol use, obesity, physical inactivity, reproductive behavior, occupational and environmental exposures, and cancer screening, are themselves substantially influenced by individual-level and area-level socioeconomic factors [2, 3, 6, 7, 15, 18–20]. …”

“…Temporal analyses can be used to track progress toward reducing health disparities as recent cancer disparities can be compared with those that existed in the previous decades [3, 6]. Comparison of cancer trends across population groups or areas may provide important insights into the impact of cancer control interventions, such as smoking cessation, cancer screening, physical activity campaigns, and cancer treatment [3–7, 10]. …”

“…Reliable individual-level SES data for all ages, especially for ages 65 and older, are lacking on US death certificates, which provide the basis for computing cancer mortality rates for various demographic groups and geographic areas [3–7, 10, 21]. Individual-level data on education and income are not available for cancer patients in the Surveillance, Epidemiology, and End Results (SEER) database, which has been the primary source of data on cancer incidence, stage at diagnosis, treatment, and survival patterns in the US for the past 4 decades [6, 10, 16, 22].…”

“…Individual-level data on education and income are not available for cancer patients in the Surveillance, Epidemiology, and End Results (SEER) database, which has been the primary source of data on cancer incidence, stage at diagnosis, treatment, and survival patterns in the US for the past 4 decades [6, 10, 16, 22]. Because of these data limitations, population-based studies of socioeconomic disparities in cancer rates have utilized area-based socioeconomic data linked to both individual- and aggregate-level cancer data [3–7, 10, 14, 17, 18]. Recent linkages of the Census and Current Population Survey (CPS) records with the National Death Index and cancer patient medical records have led to the development of longitudinal, cohort databases, allowing estimation of cancer incidence, mortality, disease stage, and survival patterns according to individual-level socioeconomic characteristics [11, 16, 23, 24].…”