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. 2023 Jan 1;9(1):122-126.
doi: 10.1001/jamaoncol.2022.5382.

Association of Residential Racial and Economic Segregation With Cancer Mortality in the US

Lu Zhang  1 , Rui Gong  2 , Lu Shi  1 , Ming Wen  3 , Xiaoqian Sun  4 , K Robin Yabroff  5 , Xuesong Han  5
Affiliations

Association of Residential Racial and Economic Segregation With Cancer Mortality in the US

Lu Zhang et al. JAMA Oncol. .

Abstract

Importance: Residential segregation is a structural risk factor for poor cancer outcomes. Previous research examining the association of residential segregation with cancer outcomes was limited by older data, restricted geographic areas, and few cancer sites. To guide targeted interventions, a comprehensive evaluation of the association between segregation and cancer outcomes is needed.

Objective: To examine the association of residential racial and economic segregation with cancer mortality at the US county level for all cancers combined and for the 13 cancer types that represent the top 10 causes of cancer deaths in males or females.

Design, setting, and participants: This ecological study used county-level sociodemographic data from the 2015-2019 American Community Survey linked with 2015-2019 county-level mortality data. Data analysis was performed from September 2021 to April 2022.

Exposures: Residential racial and economic segregation measured by the Index of Concentration at the Extremes (ICE) and categorized into quintiles 1 (most deprived) through 5 (most privileged).

Main outcomes and measures: Age-adjusted cancer mortality was the outcome. Multilevel linear mixed modeling was used to calculate the adjusted mortality rate ratio (aRR).

Results: A total of 3110 counties were included. The age-adjusted mortality rates of all cancers combined were 179.8, 177.3, 167.6, 159.6, and 146.1 per 100 000 population (P < .001 for trend) for the 5 ICE categories (most deprived to least deprived), respectively. Compared with the least deprived counties, aRRs for all cancers combined were 1.22 (95% CI, 1.20-1.24) for the most deprived counties, followed by 1.17 (95% CI, 1.15-1.19), 1.10 (95% CI, 1.09-1.12), and 1.06 (95% CI, 1.04-1.08) for the other 3 quintiles, respectively (P < .001 for trend). Segregation was associated with increased mortality from 12 of 13 selected cancer sites, in which aRRs ranged from 1.06 (95% CI, 1.02-1.09) for brain and other nervous system cancer to 1.49 (95% CI, 1.43-1.54) for lung and bronchus cancer.

Conclusions and relevance: The findings of this ecological study suggest that residential racial and economic segregation is associated with higher cancer mortality at the county level, highlighting opportunities for geographically targeted cancer prevention and control efforts.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Yabroff reported serving on the Flatiron Health Equity Advisory Board, and that all honoraria are donated to the American Cancer Society. Dr Han reported receiving grants from AstraZeneca outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Distribution of Residential Racial and Economic Segregation
Segregation is measured by quintiles of the Index of Concentration at Extremes among US counties, 2015-2019.
Figure 2.
Figure 2.. Mean Age-Adjusted Mortality Rate and Adjusted Mortality Rate Ratios for All Cancers by Residential Segregation in US Counties, 2015-2019
As measured by the Index of Concentration at the Extremes in US counties, 2015-2019, graphs show the mean age-adjusted mortality rate (A) and the adjusted mortality rate ratios (B), with the fifth quintile representing the most privileged counties and the first quintile representing the least privileged counties. The fifth quintile (horizontal dashed line) (B) was used as the reference group. Multivariable linear mixed models were clustered at the state level, weighted by county population size, and adjusted for metropolitan status, poverty level, and proportion of the population with non-Hispanic White alone race. Whiskers represent 95% CI.
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Comment in

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