Factors contributing to the poorer survival of black Americans diagnosed with oral cancer (United States)
- 72 Downloads
Objective: The purpose of this study was to identify factors that contribute to the poorer survival of blacks in the United States diagnosed with oral cancer.
Methods: Data for 6338 whites and 1165 blacks diagnosed from 1988 to 1993 with squamous cell carcinoma of the oral cavity and pharynx were obtained from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program 1973–1993 Public-Use Database. The covariables were sex, age, geographic area, marital status, socioeconomic status (five census-tract measures), stage, anatomic site, grade, lymph node involvement, tumor size, and treatment. Hazard ratios were estimated with Cox regression.
Results: Adjusted for age and geographic area, the hazard of death from oral cancer was 1.7 (95% confidence interval: 1.5–1.9) times greater among blacks than whites. The addition of the socioeconomic status (SES) variables to the model reduced the hazard ratio for race to 1.3 (1.0–1.7). Further adjustment by stage and treatment reduced the hazard ratio for race to 1.1 (0.9–1.4). In a model containing all covariables (except lymph node involvement and tumor size), the hazard ratio for race remained 1.1 (0.9–1.4). Analyses with the outcome death from any cause gave similar results.
Conclusions: Lower SES, more advanced stage, and differences in treatment accounted for 86% of the excess hazard of death from oral cancer among blacks.
Unable to display preview. Download preview PDF.
- 1.Ries LAG, Kosary CL, Hankey BF, Miller BA, Harras A, Edwards BK, eds. (1997) SEER Cancer Statistics Review, 1973–1994: tables and graphs. Bethesda, MD: National Cancer Institute. NIH Pub. No. 97-2789.Google Scholar
- 2.Anonymous (1996) AAPA statement on biological aspects of race. Am J Phys Anthropol 101: 569-570.Google Scholar
- 3.National Cancer Institute (1997) Report of the President's Cancer Panel. The meaning of race in science — considerations for cancer research. Highlights and recommendations from the President's Cancer Panel Meeting. New York: National Cancer Institute.Google Scholar
- 4.Surveillance, Epidemiology, and End Results (SEER) Program Public Use CD-ROM (1973–1993). National Cancer Institute, DCPC, Surveillance Program, Cancer Statistics Branch, 1993.Google Scholar
- 5.Krieger N, Williams DR, Moss NE (1997) Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health 18: 341-378.Google Scholar
- 6.Beahrs OH, Henson DE, Hutter RVP, Myers MH, eds. (1998) Manual for Staging of Cancer, 3rd edn. Philadelphia: JB Lippincott.Google Scholar
- 7.Cox DR (1972) Regression models and life tables. J R Stat Soc 34: 187-220.Google Scholar
- 8.Eley JW, Hill HA, Chen VW, et al. (1994) Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. JAMA 272: 947-954.Google Scholar
- 9.Freeman HP (1989) Cancer in the socioeconomically disadvantaged. CA Cancer J Clin 39: 266-288.Google Scholar
- 10.Williams DR (1997) Race and health: basic questions, emerging directions. Ann Epidemiol 7: 322-333.Google Scholar
- 11.Anonymous (1994) Examinations for oral cancer — United States, 1992. MMWR Morb Mortal Wkly Rep 43: 198-200.Google Scholar
- 12.Access to health care: key indicators for policy. Prepared by Centre for Health Economics Research for the Robert Wood Johnson Foundation. Princeton, NJ: The Foundation, 1993.Google Scholar
- 13.Mueller CD, Schur CL, Paramore LC (1998) Access to dental care in the United States. J Am Dent Assoc 129: 429-437.Google Scholar
- 14.Guidry JJ, Greisinger A, Aday LA, Winn RJ, Vernon S, Throckmorton TA (1996) Barriers to cancer treatment: a review of published research. Oncol Nurs Forum 23: 1393-1398.Google Scholar
- 15.Pamies RJ, Woodard LJ (1992) Cancer in socioeconomically disadvantaged populations. Prim Care 19: 443-450Google Scholar
- 16.Powe BD (1995) Cancer fatalism among elderly Caucasians and African Americans. Oncol Nurs Forum 22: 1355-1359.Google Scholar
- 17.Conrad ME, Brown P, Conrad MG (1996) Fatalism and breast cancer in black women [letter; comment]. Ann Intern Med 125: 941-942.Google Scholar
- 18.Peterson ED, Shaw LK, Delong ER, Pryor DB, Califf RM, Mark DB (1997) Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter? N Engl J Med 336: 480-486.Google Scholar
- 19.Allison JJ, Kiefe CI, Centor RM, Box JM, Farmer RM (1996) Racial differences in the medical treatment of elderly Medicare patients with acute myocardial infarction. J Gen Intern Med 11: 736-743.Google Scholar
- 20.McWhorter WP, Mayer WJ (1987) Black/white differences in type of initial breast cancer treatment and implications for survival. Am J Public Health 77: 1515-1517.Google Scholar
- 21.Kaufman JS, Cooper RS, McGee DL (1997) Socioeconomic status and health in blacks and whites: the problem of residual confounding and the resiliency of race. Epidemiology 8: 621-628.Google Scholar
- 22.Hyndman JC, Holman CD, Hockey RL, Donovan RJ, Corti B, Rivera J, (1995) Misclassification of social disadvantage based on geographical areas: comparison of postcode and collector's district analyses. Int J Epidemiol 24: 165-176.Google Scholar
- 23.Geronimus A, Bound J, Neidert L (1996) On the validity of using census geocode characteristics to proxy individual socioeconomic characteristics. J Am Stat Assoc 91: 529-537.Google Scholar
- 24.Geronimus AT, Bound J (1998) Use of census-based aggregate variables to proxy for socioeconomic group: evidence from national samples. Am J Epidemiol 148: 475-486.Google Scholar
- 25.Krieger N (1992) Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health 82: 703-710.Google Scholar
- 26.Blot WJ, McLaughlin JK, Winn DM, et al. (1988) Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 48: 3282-3287.Google Scholar
- 27.Day GL, Blot WJ, Austin DF, et al. (1993) Racial differences in risk of oral and pharyngeal cancer: alcohol, tobacco, and other determinants. J Natl Cancer Inst 85: 465-473.Google Scholar
- 28.Bundgaard T, Bentzen SM, Wildt J (1994) The prognostic effect of tobacco and alcohol consumption in intra-oral squamous cell carcinoma. Eur J Cancer B Oral Oncol 30B: 323-328.Google Scholar
- 29.Deleyiannis FW, Thomas DB, Vaughan TL, Davis S (1996) Alcocholism: independent predictor of survival in patients with head and neck cancer. J Natl Cancer Inst 88: 542-549.Google Scholar
- 30.Bundgaard T, Bentzen SM, Wildt J, Sorensen FB, Sogaard H, Nielsen JE (1996) Histopathologic, sterologic, epidemiologic, and clinical parameters in the prognostic evaluation of squamous cell carcinoma of the oral cavity. Head Neck 18: 142-152.Google Scholar
- 31.Yu GP, Ostroff JS, Zhang ZF, Tang J, Schantz SP (1997) Smoking history and cancer patient survival: a hospital cancer registry study. Cancer Detect Prev 21: 497-509.Google Scholar
- 32.Morgenstern H (1997) Defining and explaining race effects. Epidemiology 8: 609-611.Google Scholar
- 33.Cooper R, David R (1986) The biological concept of race and its application to public health and epidemiology. J Health Polit Policy Law 11: 97-116.Google Scholar