Racial Disparities
Overall cancer incidence and mortality rates are usually the highest with non-Hispanic black populations and the lowest for Asian/Pacific Islander populations (Seigel et al., 2019). There has been a reduction in the black-white disparity for the overall cancer mortality rate which has declined from 33% (1993) to 14% (2016). The reduction is most likely related to the dramatic decline of smoking among black teens since the early 1990s (Seigel et al., 2019).
Cancer survival rates also show racial disparities. The study reveals the five-year relative survival rates for all cancers combined for cases diagnosed from 2008 through 2014 was 67% in white populations and 62% in black populations. Black patients have lower survival rates than white patients for every cancer type except for kidney and pancreatic cancers, and the difference is 10% or higher for most of the cancers. Melanoma, uterine corpus, and oral cavity/ and pharynx cancers have the largest disparities (Seigel et al., 2019). “However, black people also have lower stage-specific survival for most cancer types. After adjusting for sex, age, and stage at diagnosis, the relative risk of death after a cancer diagnosis is 33% higher in black patients than in white patients” (Seigel et al., 2019). American Indians/Alaska Natives disparity rates are even higher where 51% are more likely to die from cancer when compared to white people (Seigel et al., 2019).
Socioeconomic Status Disparities
There has been a widening of socioeconomic disparities for the past 30 years in regard to cancer, but there are variations by cancer type. The most significant disparities are with preventable cancers. Seigel et al. (2019) provide key examples of variation between poor vs. affluent counties including:
- 50% higher cervical cancer mortality for women in poor counties
- More than 40% higher lung and liver cancer mortality for men in poor counties
The most remarkable swing is for colorectal cancers where the mortality rate for lower socioeconomic counties have gone from being 20% lower than those in more affluent counties early in the 1970s to now being 35% higher. Seigel et al. (2019) identifies changes in dietary and smoking patterns, slower proportion of screening, and treatment advances among the lower socioeconomic population. This trend was also identified earlier with lung cancer death rates when affluent men were more likely to smoke, but that trend has reversed.
It is estimated that approximately 34% of cancer deaths in U.S. for people aged 25-74 years could be avoided if socioeconomic disparities were eliminated (Seigel et al., 2019). The statistics show about a 20% higher cancer death rate for residents in the poorest counties when compared with more prosperous counties.
Geographic Variation
There are variances among states which are related to differences in medical detection and prevalence of risk factors (e.g., tobacco use, obesity, and other health behaviors). There has been an increase in disparities over time which is often reflective of poverty levels across the country (Seigel et al., 2019). The authors suggest that the variances maybe exacerbated by states that did not adopt Medicaid expansion or other initiatives to improve access to healthcare.
Seigel et al. (2019) find the largest variation is found related to lung cancer when looking at smoking prevalence. Kentucky and West Virginia have much higher rates of smokers (1 in 4 people) and when compared to Utah, Puerto Rico, and California where their rate is lower (1 in 10 people).
What Can Healthcare Providers Do?
Seigel et al. (2019) conclude their article by suggesting providers work on reaching the poorest counties with locally focused efforts to reduce preventable cancers including access to basic health care and healthcare education. Topics for education include tobacco cessation, healthy living, and cancer prevention initiatives and screenings.
