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Cancer Causes & Control

, Volume 20, Issue 6, pp 989–1000 | Cite as

County-level poverty and distant stage cancer in the United States

  • Robert T. GreenleeEmail author
  • Holly L. Howe
Original Paper

Abstract

Objective

Late stage cancer at diagnosis increases the likelihood of cancer death. We evaluated the relation of county-level poverty with late stage cancer for 18 anatomic sites using data from the North American Association of Central Cancer Registries.

Methods

Stratified analysis and logistic regression were applied to 2 million incident cancers (1997–2000) from 32 states representing 57% of the United States.

Results

For 12 sites, higher county poverty significantly increased the odds of late stage, [adjusted odds ratio (95% confidence interval) comparing highest to lowest county poverty: larynx 2.4 (1.8–3.2), oral cavity 2.2 (1.8–2.7), melanoma 2.0 (1.5–2.8), female breast 1.9 (1.7–2.2), prostate 1.7 (1.5–1.9), corpus uteri 1.6 (1.3–1.9), cervix 1.6 (1.3–2.1), bladder 1.6 (1.2–2.1), colorectum 1.4 (1.3–1.5), esophagus 1.3 (1.1–1.7), stomach 1.3 (1.1–1.5), and kidney 1.3 (1.1–1.5)]. With some exceptions, county poverty associations with stage were comparable across gender and race, but stronger among metropolitan cases. A few differences by age may reflect screening patterns.

Conclusions

In this large population-based study, higher county poverty independently predicted distant stage cancer. This held for several non-screenable cancers, suggesting improved area economic deprivation, including access to and utilization of good medical care might facilitate earlier diagnosis and longer survival even for cancers without practical screening approaches.

Keywords

Neoplasms Poverty Social class Early diagnosis 

Abbreviations

CI

Confidence interval

CINA

Cancer in North America

NAACCR

North American Association of Central Cancer Registries, Inc

NCI

National Cancer Institute

NOS

Not otherwise specified

OR

Odds ratio

SEER

Surveillance, Epidemiology, and End Results

Notes

Acknowledgment

The authors would like to thank the staff of NAACCR, Inc. and IMS, Inc. for their work in generating CINA analytic files and the NAACCR scientific editorial board for their helpful suggestions.

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Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  1. 1.Marshfield Clinic Research FoundationMarshfieldUSA
  2. 2.North American Association of Central Cancer Registries, IncSpringfieldUSA

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