(HealthDay News) — Socioeconomic and health-related behaviors contribute to county-level disparities in cancer deaths, according to a study published online in JAMA Network Open.
Jeremy M. O’Connor, MD, from the Yale University School of Medicine in New Haven, Connecticut, and colleagues used county-level median household income and death records from the 2014 National Center for Health Statistics to identify mediators between county-level median incomes and cancer death rates.
The researchers found that low-income counties (median income, $33,445) had higher proportions of residents who were non-Hispanic black, lived in rural areas, or reported poor or fair health versus high-income counties (median income, $55,780). In high-income counties, the mean cancer death rate was 185.9 per 100,000 person-years compared with 204.9 and 229.7 per 100,000 person-years in medium- and low-income counties, respectively. Health risk behaviors (smoking, obesity, and physical inactivity), clinical care factors (unaffordable care and low-quality care), health environments (food insecurity), and health policies (state smoke-free laws and Medicaid payment rates) together accounted for more than 80% of the income-related disparity. Food insecurity (explaining 19.1% of the association between county incomes and cancer deaths), low-quality care (17.9%), smoking (12.7%), and physical inactivity (12.2%) were the strongest mediators.
“The paper suggests all of these factors are interplaying to lead to disparities,” O’Connor said in a statement. “It’s not just health behaviors or quality of care; it’s all of the factors together.”
One author disclosed financial ties to the medical device industry.
O’Connor JM, Sedghi T, Dhodapkar M, Kane MJ, Gross CP. Factors Associated With Cancer Disparities Among Low-, Medium-, and High-Income US Counties.JAMA Netw Open. 2018;1(6):e183146. DOI:10.1001/jamanetworkopen.2018.3146