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

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Cancer Causes & Control Aims and scope Submit manuscript

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.

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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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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.

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Authors and Affiliations

  1. Department of Society, Human Development and Health (SHDH), Harvard School of Public Health (HSPH), 677 Huntington Avenue, Kresge 717, Boston, MA, 02115, USA

    Nancy Krieger, Jarvis T. Chen, Anna Kosheleva & Pamela D. Waterman

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  1. Nancy Krieger
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  2. Jarvis T. Chen
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  3. Anna Kosheleva
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  4. Pamela D. Waterman
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Correspondence to Nancy Krieger.

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Krieger, N., Chen, J.T., Kosheleva, A. et al. Shrinking, widening, reversing, and stagnating trends in US socioeconomic inequities in cancer mortality for the total, black, and white populations: 1960–2006. Cancer Causes Control 23, 297–319 (2012). https://doi.org/10.1007/s10552-011-9879-4

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