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. 2021 Jul;30(7):1375-1386.
doi: 10.1158/1055-9965.EPI-20-1534. Epub 2021 May 4.

Socioeconomic Inequalities in Premature Cancer Mortality Among U.S. Counties During 1999 to 2018

Suhang Song  1 , Yuqi Duan  2   3 , Junjie Huang  4 , Martin C S Wong  2   4 , Hongda Chen  5 , Michael G Trisolini  6 , Kenneth A Labresh  6 , Sidney C Smith Jr  7 , Yinzi Jin  8   3 , Zhi-Jie Zheng  2   3
Affiliations

Socioeconomic Inequalities in Premature Cancer Mortality Among U.S. Counties During 1999 to 2018

Suhang Song et al. Cancer Epidemiol Biomarkers Prev. 2021 Jul.

Abstract

Background: This study investigated socioeconomic inequalities in premature cancer mortality by cancer types, and evaluated the associations between socioeconomic status (SES) and premature cancer mortality by cancer types.

Methods: Using multiple databases, cancer mortality was linked to SES and other county characteristics. The outcome measure was cancer mortality among adults ages 25-64 years in 3,028 U.S. counties, from 1999 to 2018. Socioeconomic inequalities in mortality were calculated as a concentration index (CI) by income (annual median household income), educational attainment (% with bachelor's degree or higher), and unemployment rate. A hierarchical linear mixed model and dominance analyses were used to investigate SES associated with county-level mortality. The analyses were also conducted by cancer types.

Results: CIs of SES factors varied by cancer types. Low-SES counties showed increasing trends in mortality, while high-SES counties showed decreasing trends. Socioeconomic inequalities in mortality among high-SES counties were larger than those among low-SES counties. SES explained 25.73% of the mortality. County-level cancer mortality was associated with income, educational attainment, and unemployment rate, at -0.24 [95% (CI): -0.36 to -0.12], -0.68 (95% CI: -0.87 to -0.50), and 1.50 (95% CI: 0.92-2.07) deaths per 100,000 population with one-unit SES factors increase, respectively, after controlling for health care environment and population health.

Conclusions: SES acts as a key driver of premature cancer mortality, and socioeconomic inequalities differ by cancer types.

Impact: Focused efforts that target socioeconomic drivers of mortalities and inequalities are warranted for designing cancer-prevention implementation strategies and control programs and policies for socioeconomically underprivileged groups.

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