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Time Trends in Liver Cancer Mortality, Incidence, and Risk Factors by Unemployment Level and Race/Ethnicity, United States, 1969–2011

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Abstract

This study examined unemployment and racial/ethnic disparities in liver cancer mortality, incidence, survival, and risk factors in the United States between 1969 and 2011. Census-based unemployment rates were linked to 1969–2009 county-level mortality and incidence data, whereas 2006–2011 National Health Interview Surveys were used to examine variations in hepatitis infection and alcohol consumption. Age-adjusted mortality rates, risk-ratios, and rate-differences were calculated by year, sex, race, and county-unemployment level. Log-linear, Poisson, and logistic regression and disparity indices were used to model trends and differentials. Although liver-cancer mortality rose markedly for all groups during 1969–2011, higher unemployment levels were associated with increased mortality and incidence rates in each time period. Both absolute and relative inequalities in liver cancer mortality according to unemployment level increased over time for both males and females and for those aged 25–64 years. Compared to the lowest-unemployment group, those aged 25–64 in the highest-unemployment group had 56 and 115 % higher liver-cancer mortality in 1969–1971 and 2005–2009, respectively. Regardless of unemployment levels, Asian/Pacific Islanders and Hispanics had the highest mortality and incidence rates. The adjusted odds of hepatitis infection and heavy drinking were 38–39 % higher among the unemployed than employed. Liver-cancer mortality and incidence have risen steadily among all racial/ethnic, sex, and socioeconomic groups. Faster increases in mortality among the highest-unemployment group have led to a widening gap in mortality over time. Disparities in mortality and incidence are consistent with similar inequalities in hepatitis infection and alcohol consumption.

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References

  1. Jemal, A., Bray, F., Center, M. M., et al. (2011). Global cancer statistics. CA: A Cancer Journal for Clinicians, 61(2), 69–90.

    Article  Google Scholar 

  2. Ferlay, J., Shin, H. R., Bray, F., Forman, D., Mathers, C., & Parkin, D. M. (2010). GLOBOCAN 2008, Cancer incidence and mortality worldwide: IARC cancer base no. 10 [Internet]. Lyon, France: International Agency for Research on Cancer. Available at: http://globocan.iarc.fr. Accessed February 20, 2013.

  3. Howlader, N., Noone, A. M., Krapcho M, et al. (Eds.). (2012). SEER cancer statistics review, 1975–2009 (vintage 2009 populations). Bethesda, MD: National Cancer Institute. http://seer.cancer.gov/csr/1975_2009_pops09/index.html. Accessed February 20, 2013.

  4. American Cancer Society. (2012). Cancer facts & figures 2012. Atlanta, GA: American Cancer Society.

    Google Scholar 

  5. Jemal, A., Simard, E. P., Dorell, C., et al. (2013). Annual report to the nation on the status of cancer, 1975–2009, featuring the burden and trends in human papillomavirus (HPV)-associated cancers and HPV vaccination coverage levels. Journal of the National Cancer Institute, 105(3), 175–201.

    Article  PubMed  Google Scholar 

  6. National Center for Health Statistics. (2012). Health, United States, 2011 with special feature on socioeconomic status and health. Hyattsville, MD: US Department of Health and Human Services.

    Google Scholar 

  7. Kochanek, K. D., Xu, J. Q., Murphy, S. L., Minino, A. M., & Kung, H. C. (2011). Deaths: final data for 2009. National Vital Statistics Reports, 60(3), 1–167.

    Google Scholar 

  8. Faggiano, F., Partanen, T., Kogevinas, M., & Boffetta, P. (1997). Socioeconomic differentials in cancer incidence and mortality. IARC Scientific Publications, 138, 65–176.

    PubMed  Google Scholar 

  9. Davey Smith, G., Leon, D., Shipley, M., & Rose, G. (1991). Socioeconomic differentials in cancer among men. International Journal of Epidemiology, 20, 339–345.

    Article  Google Scholar 

  10. Davey Smith, G., Neaton, J. D., Wentworth, D., Stamler, R., & Stamler, J. (1996). Socioeconomic differentials in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: I-white men. American Journal of Public Health, 86(4), 486–496.

    Article  Google Scholar 

  11. Shebi, F. M., Capo-Ramos, D. E., Graubrad, B. I., McGlynn, K. A., & Altekruse, S. F. (2012). Socioeconomic status and hepatocellular carcinoma in the United States. Cancer Epidemiology, Biomarkers & Prevention, 21(8), 1330–1335.

    Article  Google Scholar 

  12. Menvielle, G., Kunst, A. E., Stirbu, I., Strand, B. H., Borrell, C., Regidor, E., et al. (2008). Educational differences in cancer mortality among women and men: A gender pattern that differs across Europe. British Journal of Cancer, 98(5), 1012–1019.

    Article  PubMed  CAS  Google Scholar 

  13. Menvielle, G., Kunst, A. E., Stirbu, I., Borrell, C., Bopp, M., Regidor, E., et al. (2007). Socioeconomic inequalities in alcohol related cancer mortality among men: To what extent do they differ between Western European populations. International Journal of Cancer, 121(3), 649–655.

    Article  CAS  Google Scholar 

  14. McLeod, C. B., Hall, P. A., Siddiqi, A., & Hertzman, C. (2012). How society shapes the health gradient: Work-related health inequalities in a comparative perspective. Annual Review of Public Health, 33, 59–73.

    Article  PubMed  Google Scholar 

  15. Roelfs, D. J., Shor, E., Davidson, K. W., & Schwartz, J. E. (2011). Losing life and livelihood: A systematic review and meta analysis of unemployment and all-cause mortality. Social Science and Medicine, 72(6), 840–854.

    Article  PubMed  Google Scholar 

  16. Brenner, M. H. (1995). Political economy and health. In B. C. Amick, S. Levine, A. R. Tarlov, & D. C. Walsh (Eds.), Society and health (pp. 211–246). New York, NY: Oxford University Press.

    Google Scholar 

  17. US Census Bureau. (2012). Statistical abstract of the United States, 2012. (131th ed.). Washington, DC: US Government Printing Office. http://www.census.gov/compendia/statab/.

  18. Minino, A. M., & Murphy, S. L. (2012). Death in the United States, 2010. NCHS Data Brief, 99(10), 1–8.

    PubMed  Google Scholar 

  19. Hoyert, D. L., & Xu, J. Q. (2012). Deaths: Preliminary data for 2011. National Vital Statistics Reports, 61(6), 1–52.

    Google Scholar 

  20. National Center for Health Statistics. (2012). National vital statistics system, mortality multiple cause-of-death public use data file documentation. Hyattsville, MD: US Department of Health and Human Services. Available at: http://www.cdc.gov/nchs/nvss/mortality_public_use_data.htm. Accessed January 25, 2013.

  21. US Census Bureau. (1992). Census of population and housing, 1990: Summary tape file 3A on CD-ROM. Washington, DC: US Department of Commerce.

    Google Scholar 

  22. US Census Bureau. (2005). Summary file 3, technical documentation. 2000 census of population and housing. Washington, DC: US Department of Commerce.

    Google Scholar 

  23. US Census Bureau. (2010). The 2009 American Community Survey. Washington, DC: US Census Bureau. http://www.census.gov/acs/www/. Accessed January 25, 2013.

  24. Schiller, J. S., Lucas, J. W., Ward, B. W., & Peregoy, J. A. (2012). Summary health statistics for U.S. adults: National Health Interview Survey, 2010. Vital and Health Statistics, 10(252), 1–207.

    Google Scholar 

  25. National Center for Health Statistics. (2012). The National Health Interview Survey, Questionnaires, datasets, and related documentation: 2006–2011 public use data files. Hyattsville, MD: US Department of Health and Human Services. Available at: http://www.cdc.gov/nchs/nhis/nhis_questionnaires.htm. Accessed January 18, 2013.

  26. Research Triangle Institute. (2009). SUDAAN: Software for the statistical analysis of correlated data, release 10.0.1. Research Triangle Park, NC: Research Triangle Institute.

    Google Scholar 

  27. Singh, G. K., Siahpush, M., & Williams, S. D. (2012). Changing urbanization patterns in US lung cancer mortality, 1950–2007. Journal of Community Health, 37(2), 412–420.

    Article  PubMed  Google Scholar 

  28. SAS Institute, Inc. (2004). SAS/STAT user’s guide, version 9.1: The GENMOD procedure. Cary, NC: SAS Institute Inc.

    Google Scholar 

  29. Singh, G. K., Siahpush, M., Hiatt, R. A., & Timsina, L. R. (2011). Dramatic increases in obesity and overweight prevalence and body mass index among ethnic-immigrant and social class groups in the United States, 1976–2008. Journal of Community Health, 36(1), 94–110.

    Article  PubMed  CAS  Google Scholar 

  30. Singh, G. K., Williams, S. D., Siahpush, M., & Mulhollen, A. (2011). Socioeconomic, rural-urban, and racial inequalities in US cancer mortality: Part 1—all cancers and lung cancer and part II—colorectal, prostate, breast, and cervical cancers. Journal of Cancer Epidemiology, 107497, 1–27. doi:10.1155/2011/107497.

    Article  Google Scholar 

  31. Singh, G. K., Miller, B. A., Hankey, B. F., & Edwards, B. K. (2003). Area socioeconomic variations in U.S. cancer incidence, mortality, stage, treatment, and survival, 1975–1999. NCI Cancer Surveillance Monograph Series, No. 4. Bethesda, MD: National Cancer Institute. NIH publication no. 03-5417. http://seer.cancer.gov/publications/ses/index.html.

  32. Singh, G. K., & Hiatt, R. A. (2006). Trends and disparities in socioeconomic and behavioral characteristics, life expectancy, and cause-specific mortality of native-born and foreign-born populations in the United States, 1979–2003. International Journal of Epidemiology, 35(4), 903–919.

    Article  PubMed  Google Scholar 

  33. Singh, G. K., & Miller, B. A. (2004). Health, life expectancy, and mortality patterns among immigrant populations in the United States. Canadian Journal of Public Health, 95(3), I14–I21.

    PubMed  Google Scholar 

  34. Siahpush, M., Singh, G. K., Jones, P. R., & Timsina, L. R. (2010). Racial/ethnic and socioeconomic variations in duration of smoking: Results from the 2003, 2006, and 2007 Tobacco Use Supplement of the Current Population Survey. Journal of Public Health, 32(2), 210–218.

    Article  PubMed  CAS  Google Scholar 

  35. International Agency for Research on Cancer (IARC). (2011). WHO cancer mortality database. World Health Organization, International Agency for Research on Cancer. Available at: http://www-dep.iarc.fr/WHOdb/WHOdb.htm. Accessed February 22, 2013.

  36. Organisation for Economic Co-operation and Development (OECD). (2012). Obesity update 2012. Paris, France: OECD. http://www.oecd.org/health/49716427.pdf.

  37. World Health Organization. (2011). World health statistics report 2011. Geneva, Switzerland: WHO.

    Google Scholar 

  38. McQuillan, G. M., Kruszon-Moran, D., Denniston, M. M., & Hirsch, R. (2010). Viral hepatitis. NCHS Data Brief, 27(10), 1–8.

    Google Scholar 

  39. Sorlie, P. D., Backlund, E., & Keller, J. B. (1995). US mortality by economic, demographic, and social characteristics: The National Longitudinal Mortality Study. American Journal of Public Health, 85(7), 949–956.

    Article  PubMed  CAS  Google Scholar 

  40. US Census Bureau. (2007). National longitudinal mortality study, reference manual. Washington, DC: US Census Bureau. http://www.census.gov/did/www/nlms/publications/reference.html.

  41. National Cancer Intelligence Network (NCIN). (2008). Cancer incidence by deprivation, England, 1995–2004. London: NCIN. http://www.ncin.org.uk/.

  42. Puigpinos, R., Borerell, C., Antunes, J. L. F., et al. (2009). Trends in socioeconomic inequalities in cancer mortality in Barcelona: 1992–2003. BMC Public Health, 9(35), 1–9.

    Google Scholar 

  43. Nishi, N., Sugiyama, H., Hsu, W. L., et al. (2008). Differences in mortality and incidence for major sites of cancer by education level in a Japanese population. Annals of Epidemiology, 18(7), 584–591.

    Article  PubMed  Google Scholar 

  44. Joshi, S., Song, Y. M., Kim, T. H., & Cho, S. I. (2008). Socioeconomic status and the risk of liver cancer mortality: A prospective study in Korean men. Public Health, 122(11), 1144–1151.

    Article  PubMed  CAS  Google Scholar 

  45. Bureau of Health Professions. (2012). Area resource file, 2011–12, technical documentation. Rockville, MD: Health Resources and Services Administration.

    Google Scholar 

  46. US Department of Health and Human Services. (2012). Healthy people 2020. Available at: http://www.healthypeople.gov/2020/default.aspx. Accessed February 20, 2013.

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Authors and Affiliations

  1. US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 5600 Fishers Lane, Room 18-41, Rockville, MD, 20857, USA

    Gopal K. Singh

  2. Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, NE, 68198-4365, USA

    Mohammad Siahpush

  3. National Institutes of Health, National Cancer Institute, Surveillance Research Program, 6116 Executive Boulevard, Suite 504, Rockville, MD, 20852, USA

    Sean F. Altekruse

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  1. Gopal K. Singh
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Correspondence to Gopal K. Singh.

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The views expressed are the authors’ and not necessarily those of the Health Resources and Services Administration or the US Department of Health and Human Services.

Human Subjects Review: No IRB approval was required for this study, which is based on the secondary analysis of public-use federal databases.

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Singh, G.K., Siahpush, M. & Altekruse, S.F. Time Trends in Liver Cancer Mortality, Incidence, and Risk Factors by Unemployment Level and Race/Ethnicity, United States, 1969–2011. J Community Health 38, 926–940 (2013). https://doi.org/10.1007/s10900-013-9703-z

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  • DOI: https://doi.org/10.1007/s10900-013-9703-z

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