In recent decades, fewer Americans overall are dying from cancer, and yet major disparities in cancer mortality rates still exist and continue to grow across the nation.
In a new study, Yale researchers have identified specific socioeconomic and behavioral factors that may be contributing to these widening cancer death disparities in the United States. The key factors include food insecurity, smoking, physical inactivity and quality of health care.
For the study, the researchers looked at publicly available data documenting cancer mortality rates by county and compared the rates of cancer deaths in low-, medium-, and high-income counties. Using a novel method known as mediation analysis, the researchers confirmed that there are significant county-level disparities in cancer deaths, ranging from 186 deaths per 100,000 persons in high-income counties to 230 deaths per 100,000 persons in low-income counties.
“The most important of these factors appear to be food insecurity, smoking, physical inactivity, and the quality of health care that is provided in the counties,” said first author Jeremy O’Connor, M.D., who conducted the research while he was a National Clinician Scholar at Yale School of Medicine.
The findings show that cancer death disparities can be attributed to a mix of factors that involve both income and behavior. “The paper suggests all of these factors are interplaying to lead to disparities,” O’Connor noted. “It’s not just health behaviors or quality of care; it’s all of the factors together.”
As part of their methodology, the researchers also created maps that illustrate the cancer death disparity rates. This approach will allow public health officials in different parts of the country to identify specific factors that affect their counties, and respond accordingly.
“Instead of every county addressing all eight factors, they can target their public health programs to the factors that are most important to their community,” said O’Connor.
The study also highlights the fact that while overall cancer death rates are affected by advances in cancer treatment, much of the disparities in death rates might be attributable to issues outside of treatment, such as smoking and obesity, the researchers said.
In 2018, an estimated 1,735,350 new cases of cancer will be diagnosed in the United States and 609,640 people will die from the disease, according to the National Cancer Institute. Between 1990 and 2014, the overall cancer death rate has fallen 25 percent in the United States.
The new findings are published in the journal JAMA Network Open.
Source: Yale University