Cancer Causes & Control

, Volume 23, Issue 2, pp 297–319 | Cite as

Shrinking, widening, reversing, and stagnating trends in US socioeconomic inequities in cancer mortality for the total, black, and white populations: 1960–2006

  • Nancy Krieger
  • Jarvis T. Chen
  • Anna Kosheleva
  • Pamela D. Waterman
Original paper
First Online:
Received:
Accepted:

Abstract

Objectives of study

To test recent claims that cancer inequities are bound to increase as population health improves.

Methods

We analyzed 1960–2006 age-standardized US county cancer mortality data, total and site-specific (lung, prostate, colorectal, breast, cervix, stomach), stratified by county income quintile for the US total, black, and white populations.

Results

Between 1960 and 2006, US socioeconomic inequities in cancer mortality variously shrunk, widened, reversed, and stagnated, depending on time period and cancer site. For all cancers combined and most, but not all, sites, absolute, but not relative, socioeconomic gaps were greater for the black compared to white population. Compared to the yearly age-specific mortality rates among whites in the most affluent counties, the percent of excess cancer deaths among whites in the lower four county income quintiles first rose above 0 in 1990 and in 2006 equaled 5.4% (95% CI 4.8, 6.0); among blacks, it rose from 6.0% (95% CI 4.5, 7.4) in 1960 to 24.7% (95% CI 23.9, 25.5) in 1990 and remained at this level through 2006.

Conclusions

The hypothesis that cancer mortality inequities are bound to increase is refuted by long-term data on total and site-specific cancer mortality stratified by socioeconomic position and race/ethnicity.

Keywords

Black Cancer mortality Secular trends Socioeconomic inequalities Race/ethnicity 

Abbreviations

CDC

Centers for disease control and prevention

CI

Confidence interval

ICD

International classification of disease

MRD

Mortality rate difference

MRR

Mortality rate ratio

NCHS

National center for health statistics

PAF

Population attributable fraction

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Notes

Acknowledgments

We thank Jacob Bor (doctoral student, Harvard School of Public Health) for his work, as a paid research assistant, in harmonizing the ICD codes used in these analyses (permission for this acknowledgment obtained in writing on October 5, 2010). This work was supported by the National Cancer Institute at the National Institutes of Health (grant 1R03CA137666). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. All authors had full access to all of the data in the study, and the corresponding author has final responsibility for the collective decision to submit for publication.

Supplementary material

10552_2011_9879_MOESM1_ESM.doc (52 kb)
Supplementary material 1 (DOC 52 kb)

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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Nancy Krieger
    • 1
  • Jarvis T. Chen
    • 1
  • Anna Kosheleva
    • 1
  • Pamela D. Waterman
    • 1
  1. 1.Department of SocietyHuman Development and Health (SHDH), Harvard School of Public Health (HSPH)BostonUSA

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