Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 6;32(3):387-397.
doi: 10.1158/1055-9965.EPI-22-0738.

Area-level Socioeconomic Disadvantage and Cancer Survival in Metropolitan Detroit

Natalie G Snider  1 , Theresa A Hastert  1   2 , Mrudula Nair  1 , Madhav Kc  3 , Julie J Ruterbusch  1   2 , Ann G Schwartz  1   2 , Edward S Peters  4 , Elena M Stoffel  5 , Laura S Rozek  6 , Kristen S Purrington  1   2
Affiliations

Area-level Socioeconomic Disadvantage and Cancer Survival in Metropolitan Detroit

Natalie G Snider et al. Cancer Epidemiol Biomarkers Prev. .

Abstract

Background: Racial segregation is linked to poorer neighborhood quality and adverse health conditions among minorities, including worse cancer outcomes. We evaluated relationships between race, neighborhood social disadvantage, and cancer survival.

Methods: We calculated overall and cancer-specific survival for 11,367 non-Hispanic Black (NHB) and 29,481 non-Hispanic White (NHW) individuals with breast, colorectal, lung, or prostate cancer using data from the Metropolitan Detroit Cancer Surveillance System. The area deprivation index (ADI) was used to measure social disadvantage at the census block group level, where higher ADI is associated with poorer neighborhood factors. Associations between ADI and survival were estimated using Cox proportional hazards mixed-effects models accounting for geographic grouping and adjusting for demographic and clinical factors.

Results: Increasing ADI quintile was associated with increased overall mortality for all four cancer sites in multivariable-adjusted models. Stratified by race, these associations remained among breast (NHW: HR = 1.16, P < 0.0001; NHB: HR = 1.20, P < 0.0001), colorectal (NHW: HR = 1.11, P < 0.0001; NHB: HR = 1.09, P = 0.00378), prostate (NHW: HR = 1.18, P < 0.0001; NHB: HR = 1.18, P < 0.0001), and lung cancers (NHW: HR = 1.06, P < 0.0001; NHB: HR = 1.07, P = 0.00177). Cancer-specific mortality estimates were similar to overall mortality. Adjustment for ADI substantially attenuated the effects of race on mortality for breast [overall proportion attenuated (OPA) = 47%, P < 0.0001; cancer-specific proportion attenuated (CSPA) = 37%, P < 0.0001] prostate cancer (OPA = 51%, P < 0.0001; CSPA = 56%, P < 0.0001), and colorectal cancer (OPA = 69%, P = 0.032; CSPA = 36%, P = 0.018).

Conclusions: Area-level socioeconomic disadvantage is related to cancer mortality in a racially diverse population, impacting racial differences in cancer mortality.

Impact: Understanding the role of neighborhood quality in cancer survivorship could improve community-based intervention practices.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: The authors declare no conflicts of interest with this work.

Figures

Figure 1.
Figure 1.. Adjusted overall survival curves stratified by cancer site and ADI quintile.
Survival curves adjusted for race and age at diagnosis are shown for (a) overall survival for breast cancer, (b) overall survival for colorectal cancer, (c) overall survival for lung cancer, and (d) overall survival for prostate cancer. Individual survival curves are show in each graph for each ADI quintile (Q): solid light gray for Q1, dashed light gray for Q2, solid dark gray for Q3, dashed dark gray for Q4, and solid black for Q5. Higher ADI quintile corresponds to poorer neighborhood factors.
Figure 2.
Figure 2.. Adjusted cancer-specific survival curves stratified by cancer site and ADI quintile.
Survival curves adjusted for race and age at diagnosis are shown for (a) breast cancer-specific survival, (b) colorectal cancer-specific survival, (c) lung cancer-specific survival, and (d) prostate cancer-specific survival. Individual survival curves are show in each graph for each ADI quintile (Q): solid light gray for Q1, dashed light gray for Q2, solid dark gray for Q3, dashed dark gray for Q4, and solid black for Q5. Higher ADI quintile corresponds to poorer neighborhood factors.
See this image and copyright information in PMC

References

    1. Cancer Facts & Figures 2022. | American Cancer Society [Internet]. [cited 2022 Sep 27]. Available from: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts...
    1. Moke DJ, Tsai K, Hamilton AS, Hwang A, Liu L, Freyer DR, et al. Emerging Cancer Survival Trends, Disparities, and Priorities in Adolescents and Young Adults: A California Cancer Registry-Based Study. JNCI Cancer Spectr. 2019;3:pkz031. - PMC - PubMed
    1. White A, Joseph D, Rim SH, Johnson CJ, Coleman MP, Allemani C. Colon cancer survival in the United States by race and stage (2001–2009): findings from the CONCORD-2 study. Cancer. 2017;123:5014–36. - PMC - PubMed
    1. Richards TB, Henley SJ, Puckett MC, Weir HK, Huang B, Tucker TC, et al. Lung Cancer Survival in the United States by Race and Stage (2001–2009): Findings From the CONCORD-2 Study. Cancer. 2017;123:5079–99. - PMC - PubMed
    1. Steele CB, Li J, Huang B, Weir HK. Prostate Cancer Survival in the United States by Race and Stage (2001–2009): Findings From the CONCORD-2 Study. Cancer. 2017;123:5160–77. - PMC - PubMed

Publication types