Area-level Socioeconomic Disadvantage and Cancer Survival in Metropolitan Detroit

Natalie G Snider; Theresa A Hastert; Mrudula Nair; Madhav Kc; Julie J Ruterbusch; Ann G Schwartz; Edward S Peters; Elena M Stoffel; Laura S Rozek; Kristen S Purrington

doi:10.1158/1055-9965.EPI-22-0738

Area-level Socioeconomic Disadvantage and Cancer Survival in Metropolitan Detroit

Cancer Epidemiol Biomarkers Prev. 2023 Mar 6;32(3):387-397. doi: 10.1158/1055-9965.EPI-22-0738.

Authors

Natalie G Snider¹, Theresa A Hastert^{1

2}, Mrudula Nair¹, Madhav Kc³, Julie J Ruterbusch^{1

2}, Ann G Schwartz^{1

2}, Edward S Peters⁴, Elena M Stoffel⁵, Laura S Rozek⁶, Kristen S Purrington^{1

2}

Affiliations

¹ Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.
² Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan.
³ Department of Internal Medicine, Yale School of Medicine, Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, Connecticut.
⁴ Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
⁵ Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan.
⁶ Department of Oncology, Georgetown University School of Medicine, Washington, District of Columbia.

Abstract

Background: Racial segregation is linked to poorer neighborhood quality and adverse health conditions among minorities, including worse cancer outcomes. We evaluated relationships between race, neighborhood social disadvantage, and cancer survival.

Methods: We calculated overall and cancer-specific survival for 11,367 non-Hispanic Black (NHB) and 29,481 non-Hispanic White (NHW) individuals with breast, colorectal, lung, or prostate cancer using data from the Metropolitan Detroit Cancer Surveillance System. The area deprivation index (ADI) was used to measure social disadvantage at the census block group level, where higher ADI is associated with poorer neighborhood factors. Associations between ADI and survival were estimated using Cox proportional hazards mixed-effects models accounting for geographic grouping and adjusting for demographic and clinical factors.

Results: Increasing ADI quintile was associated with increased overall mortality for all four cancer sites in multivariable-adjusted models. Stratified by race, these associations remained among breast (NHW: HR = 1.16, P < 0.0001; NHB: HR = 1.20, P < 0.0001), colorectal (NHW: HR = 1.11, P < 0.0001; NHB: HR = 1.09, P = 0.00378), prostate (NHW: HR = 1.18, P < 0.0001; NHB: HR = 1.18, P < 0.0001), and lung cancers (NHW: HR = 1.06, P < 0.0001; NHB: HR = 1.07, P = 0.00177). Cancer-specific mortality estimates were similar to overall mortality. Adjustment for ADI substantially attenuated the effects of race on mortality for breast [overall proportion attenuated (OPA) = 47%, P < 0.0001; cancer-specific proportion attenuated (CSPA) = 37%, P < 0.0001] prostate cancer (OPA = 51%, P < 0.0001; CSPA = 56%, P < 0.0001), and colorectal cancer (OPA = 69%, P = 0.032; CSPA = 36%, P = 0.018).

Conclusions: Area-level socioeconomic disadvantage is related to cancer mortality in a racially diverse population, impacting racial differences in cancer mortality.

Impact: Understanding the role of neighborhood quality in cancer survivorship could improve community-based intervention practices.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Ethnicity
Humans
Neoplasms* / mortality
Socioeconomic Disparities in Health*
Socioeconomic Factors

Abstract

Publication types

MeSH terms

Grants and funding