Cancer Causes & Control

, Volume 27, Issue 4, pp 553–560 | Cite as

Age at cancer diagnosis, amenability to medical interventions, and racial/ethnic disparities in cancer mortality

  • Parisa TehranifarEmail author
  • Abhishek Goyal
  • Jo C. Phelan
  • Bruce G. Link
  • Yuyan Liao
  • Xiaozhou Fan
  • Manisha Desai
  • Mary Beth Terry
Original paper



Racial disparities in cancer mortality may be greater for cancers that are amenable to available early detection and treatment (amenability level). We investigated whether these patterns vary by age at cancer diagnosis.


Using 5-year relative survival rates (5Y-RSR), we classified 51 cancer sites into least amenable, partly amenable, and mostly amenable cancers (<40 %, 40–69 %, ≥70 % 5-YRS, respectively). We examined whether racial disparities in mortality rates (African-Americans, Asian/Pacific Islanders, Hispanics, whites), as estimated through Cox regression models, were modified by age at diagnosis and amenability level in 516,939 cancer cases diagnosed in 1995–1999.


As compared with whites, all racial minority groups experienced higher cancer mortality rates in the youngest age group of 20–34 years. African-Americans and Hispanics diagnosed with partly and mostly amenable cancers had higher mortality rates relative to whites with cancers of the same amenability levels; further, these differences decreased in magnitude or reversed in direction with increasing age. In contrast, the racial differences in mortality were smaller and remained fairly constant across age groups for least amenable cancers. For example, in the youngest (20–34) and oldest (80–99) age groups, the adjusted hazard ratios (HRs) for African-Americans versus whites with least amenable cancers were, respectively, 1.26 (95 % CI 1.02, 1.55) and 0.90 (95 % CI 0.85, 0.96), while the HRs for African-Americans versus whites with mostly amenable cancers were 2.77 (95 % CI 2.38, 3.22) and 1.07 (95 % CI 0.98, 1.17).


Cancer survival disadvantage for racial minorities is larger in younger age groups for cancers that are more amenable to medical interventions.


Age Racial/ethnic disparities Cancer mortality Medical advances Survival factors 



This work was supported by the National Cancer Institute (K07CA151777) and Live Strong foundation.

Authors’ contributions

P. Tehranifar conceived of the research question, directed data analysis, and wrote the manuscript. A. Goyal, Y. Liao, and X. Fan obtained data, performed statistical analysis, and prepared tables and figures. A. Goyal participated in writing of the manuscripts. J.C. Phelan and B.G. Link provided guidance on the research questions and interpretation of results. M. Desai provided guidance of statistical analysis. M.B. Terry provided guidance on all aspects of the manuscript and participated in writing of the manuscript. All authors reviewed the manuscript and provided feedback.

Compliance with ethical standards

Conflict of interest

The authors state that they have no conflict of interest.

Ethical approval

This study was determined by the Columbia University Medical Center Institutional Review Board (IRB) to be exempt from IRB oversight.

Supplementary material

10552_2016_729_MOESM1_ESM.pptx (187 kb)
Supplementary material 1 (PPTX 187 kb)


  1. 1.
    Jemal A, Clegg LX, Ward E, LA Ries WX, Jamison PM, Wingo PA, Howe HL, Anderson RN, Edwards BK (2004) Annual report to the nation on the status of cancer, 1975–2001, with a special feature regarding survival. Cancer 101:3–27CrossRefPubMedGoogle Scholar
  2. 2.
    Phelan JC, Link BG (2015) Is racism a fundamental cause of inequalities in health? Annu Rev Sociol 4:311–330CrossRefGoogle Scholar
  3. 3.
    Phelan JC, Link BG, Tehranifar P (2010) Social conditions as fundamental causes of health inequalities: theory, evidence and policy impliactions. J Health Soc Behav 51(Suppl):S28–S40CrossRefPubMedGoogle Scholar
  4. 4.
    Williams DR, Jackson PB (2005) Social sources of racial disparities in health. Health Aff (Millwood) 24(2):325–334. doi: 10.1377/hlthaff.24.2.325 CrossRefGoogle Scholar
  5. 5.
    Williams DR, Mohammed SA, Leavell J, Collins C (2010) Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities. Ann N Y Acad Sci 1186:69–101. doi: 10.1111/j.1749-6632.2009.05339.x CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Phelan JC, Link BG, Diez-Roux A, Kawachi I, Levin B (2004) “Fundamental Causes” of social inequalities in mortality: a test of the theory. J Health Soc Behav 45:265–285CrossRefPubMedGoogle Scholar
  7. 7.
    Link BG, Phelan J (1995) Social conditions as fundamental causes of disease. J Health Soc Behav 35:80–94CrossRefGoogle Scholar
  8. 8.
    Tehranifar P, Neugut AI, Phelan JC, Link BG, Liao Y, Desai M, Terry MB (2009) Medical advances and racial/ethnic disparities in cancer survival. Cancer Epidemiol Biomarkers Prev. doi: 10.1158/1055-9965.EPI-09-0305 PubMedPubMedCentralGoogle Scholar
  9. 9.
    Dannefer D (2003) Cumulative advantage/disadvantage and the life course: cross-fertilizing age and social science theory. J Gerontol B Psychol Sci Soc Sci 58(6):S327–S337CrossRefPubMedGoogle Scholar
  10. 10.
    Kim J, Durden E (2007) Socioeconomic status and age trajectories of health. Soc Sci Med 65(12):2489–2502. doi: 10.1016/j.socscimed.2007.07.022 CrossRefPubMedGoogle Scholar
  11. 11.
    House JS, Kessler RC, Herzog AR (1990) Age, socioeconomic status, and health. Milbank Q 68(3):383–411CrossRefPubMedGoogle Scholar
  12. 12.
    Kim J, Miech R (2009) The Black–White difference in age trajectories of functional health over the life course. Soc Sci Med 68(4):717–725. doi: 10.1016/j.socscimed.2008.12.021 CrossRefPubMedGoogle Scholar
  13. 13.
    Ferraro KF, Farmer MM (1996) Double jeopardy, aging as leveler, or persistent health inequality? A longitudinal analysis of white and black Americans. J Gerontol B Psychol Sci Soc Sci 51(6):S319–S328CrossRefPubMedGoogle Scholar
  14. 14.
    Sorlie PD, Backlund E, Keller JB (1995) US mortality by economic, demographic, and social characteristics: the National Longitudinal Mortality Study. Am J Public Health 85(7):949–956CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Dupre ME (2007) Educational differences in age-related patterns of disease: reconsidering the cumulative disadvantage and age-as-leveler hypotheses. J Health Soc Behav 48(1):1–15CrossRefPubMedGoogle Scholar
  16. 16.
    Surveillance Epidemiology and End Results (SEER) Program (, National Cancer Institute D, Surveillance Research Program, Cancer Statistics Branch
  17. 17.
    Henson DE, Ries LA (1995) The relative survival rate. Cancer 76(10):1687–1688CrossRefPubMedGoogle Scholar
  18. 18.
    Singh GK, Miller BA, Hankey BF, Edwards BK (2007) Area socioeconomic variations in U.S. cancer incidence, mortality, stage, treatment, and survival, 1975–1999. NCI Cancer Surveillance Monograph Series, Number 4. NCI Cancer Surveillance Monograph Series, National Cancer Institute, NIH Publication No. 03-0000. Bethesda, MDGoogle Scholar
  19. 19.
    Hosmer DW, Lemeshow S, May S (2008) Applied survival analysis: regression modeling of time-to-event data. Wiley series in probability and statistics, 2nd edn. Wiley, HobokenCrossRefGoogle Scholar
  20. 20.
    Phelan JC, Link BG (2005) Controlling disease and creating disparities: a fundamental cause perspective. J Gerontol 60B:27–33CrossRefGoogle Scholar
  21. 21.
    House JS, Lantz PM, Herd P (2005) Continuity and change in the social stratification of aging and health over the life course: evidence from a nationally representative longitudinal study from 1986 to 2001/2002 (Americans’ Changing Lives Study). J Gerontol Ser B Psychol Sci Soc Sci 60:15–26CrossRefGoogle Scholar
  22. 22.
    Masters RK (2012) Uncrossing the US black–white mortality crossover: the role of cohort forces in life course mortality risk. Demography 49(3):773–796. doi: 10.1007/s13524-012-0107-y CrossRefPubMedGoogle Scholar
  23. 23.
    Lynch SM (2003) Cohort and life-course patterns in the relationship between education and health: a hierarchical approach. Demography 40(2):309–331CrossRefPubMedGoogle Scholar
  24. 24.
    Masters RK, Hummer RA, Powers DA, Beck A, Lin SF, Finch BK (2014) Long-term trends in adult mortality for U.S. Blacks and Whites: an examination of period- and cohort-based changes. Demography 51(6):2047–2073. doi: 10.1007/s13524-014-0343-4 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Harper S, Lynch J (2005, NIH Publication No. 05-5777) Selected comparisons of measures of health disparities: a review using databases relevant to healthy people 2010. NCI Cancer Surveillance Monograph Series, Bethesda, MDGoogle Scholar
  26. 26.
    Byers T (2010) Two decades of declining cancer mortality: progress with disparity. Annu Rev Public Health 31:121–132. doi: 10.1146/annurev.publhealth.121208.131047 CrossRefPubMedGoogle Scholar
  27. 27.
    Gerend MA, Pai M (2008) Social determinants of Black–White disparities in breast cancer mortality: a review. Cancer Epidemiol Biomarkers Prev 17(11):2913–2923. doi: 10.1158/1055-9965.EPI-07-0633 CrossRefPubMedGoogle Scholar
  28. 28.
    Rubin MS, Colen CG, Link BG (2010) Examination of inequalities in HIV/AIDS mortality in the United States from a fundamental cause perspective. Am J Public Health 100(6):1053–1059. doi: 10.2105/AJPH.2009.170241 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Miech RA, Kumanyika SK, Stettler N, Link BG, Phelan JC, Chang VW (2006) Trends in the association of poverty with overweight among US adolescents, 1971–2004. JAMA 295(20):2385–2393. doi: 10.1001/jama.295.20.2385 CrossRefPubMedGoogle Scholar
  30. 30.
    Wang A, Clouston SA, Rubin MS, Colen CG, Link BG (2012) Fundamental causes of colorectal cancer mortality: the implications of informational diffusion. Milbank Q 90(3):592–618. doi: 10.1111/j.1468-0009.2012.00675.x CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Parisa Tehranifar
    • 1
    • 2
    Email author
  • Abhishek Goyal
    • 1
  • Jo C. Phelan
    • 3
  • Bruce G. Link
    • 1
    • 3
    • 4
  • Yuyan Liao
    • 1
  • Xiaozhou Fan
    • 1
  • Manisha Desai
    • 5
  • Mary Beth Terry
    • 1
    • 2
    • 6
  1. 1.Department of EpidemiologyColumbia University Mailman School of Public HealthNew YorkUSA
  2. 2.Herbert Irving Comprehensive Cancer CenterColumbia University Medical CenterNew YorkUSA
  3. 3.Department of Sociomedical SciencesColumbia University Mailman School of Public HealthNew YorkUSA
  4. 4.Department of Public PolicyUniversity of California RiversideRiversideUSA
  5. 5.Department of Medicine, Division of General Medical DisciplinesStanford UniversityPalo AltoUSA
  6. 6.The Imprints Center for Genetic and Environmental Lifecourse StudiesColumbia UniversityMailman School of Public HealthNew YorkUSA

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