Search

Background: Cancer contributes substantially to the life expectancy gap between US blacks and whites, and racial cancer disparities remain stubborn to eradicate. Disparities vary geographically, suggesting that they are not inevitable.Methods: The authors examined the relationship between housing discrimination and the size of cancer disparities across large US metropolitan statistical areas (MSAs). MSA-level cancer disparities were measured using data from the US Centers for Disease Control and Prevention. Mortgage discrimination for each MSA was estimated using the Home Mortgage Disclosure Act database, and MSA racial segregation was determined using US Census data. Patterns of housing discrimination and cancer disparities were mapped, and the associations between these place-based factors and cancer disparities across MSAs were measured.Results: Black-to-white cancer mortality disparities (rate ratios) varied geographically, ranging from 1.50 to 0.86; 88% of mortality ratios were >1, indicating higher mortality for blacks. In areas with greater mortgage discrimination, the gap between black and white cancer mortality rates was larger (correlation coefficient [r] = 0.32; P = .001). This relationship persisted in sex-specific analyses (males, r = 0.37; P < .001; females, r = 0.23; P = .02) and in models controlling for confounders. In contrast, segregation was inconsistently associated with disparities. Adjusting for incidence disparities attenuated, but did not eliminate, the correlation between mortgage discrimination and mortality disparities (r = 0.22-0.24), suggesting that cancer incidence and survival each account for part of the mortality disparity.Conclusions: Mortgage discrimination is associated with larger black-to-white cancer mortality disparities. Some areas are exceptions to this trend. Examination of these exceptions and of policies related to housing discrimination may offer novel strategies for explaining and eliminating cancer disparities. [ABSTRACT FROM AUTHOR]

Background Urban sprawl has the potential to influence cancer mortality via direct and indirect effects on obesity, access to health services, physical activity, transportation choices and other correlates of sprawl and urbanization. Methods This paper presents a cross-sectional analysis of associations between urban sprawl and cancer mortality in urban and suburban counties of the United States. This ecological analysis was designed to examine whether urban sprawl is associated with total and obesity-related cancer mortality and to what extent these associations differed in different regions of the US. A major focus of our analyses was to adequately account for spatial heterogeneity in mortality. Therefore, we fit a series of regression models, stratified by gender, successively testing for the presence of spatial heterogeneity. Our resulting models included county level variables related to race, smoking, obesity, access to health services, insurance status, socioeconomic position, and broad geographic region as well as a measure of urban sprawl and several interactions. Our most complex models also included random effects to account for any county-level spatial autocorrelation that remained unexplained by these variables. Results Total cancer mortality rates were higher in less sprawling areas and contrary to our initial hypothesis; this was also true of obesity related cancers in six of seven U.S. regions (census divisions) where there were statistically significant associations between the sprawl index and mortality. We also found significant interactions (p < 0.05) between region and urban sprawl for total and obesity related cancer mortality in both sexes. Thus, the association between urban sprawl and cancer mortality differs in different regions of the US. Conclusions Despite higher levels of obesity in more sprawling counties in the US, mortality from obesity related cancer was not greater in such counties. Identification of disparities in cancer mortality within and between geographic regions is an ongoing public health challenge and an opportunity for further analytical work identifying potential causes of these disparities. Future analyses of urban sprawl and health outcomes should consider exploring regional and international variation in associations between sprawl and health. [ABSTRACT FROM AUTHOR]

Abstract: Background: Reaching the American Cancer Society challenge goal for the nation to reduce cancer incidence by 25% by 2015 will be influenced in part by the epidemic of obesity. The purpose of this study was to estimate the impact of obesity on the number obesity-attributable incident cancers in the U.S. in 2007 and on trends on cancer incidence rates. Methods: Using estimated relative risks (RRs) for obesity vs. normal weight/height from published meta-analyses and/or large cohort studies, and the prevalence of obese adults from the latest national surveys, attributable risk percent (ARP) and numbers of obesity-attributed incident cancers in 2007 were estimated. Using the ARPs, the impact of obesity trends on trends in incidence rates for certain obesity-related cancers was estimated for the calendar years (1976–1980 through 2001–2004) for which cancer rates and obesity prevalence rates were available. Results: An estimated 33,966 new cancers (4% of all estimated cancers) in males and 50,535 (7% of all estimated cancers) in females diagnosed in 2007, or 6% of all cancers, may be potentially attributable to obesity. Without the impact of rising obesity rates, incidence rates might have declined (instead of remaining stable) from 1988–1994 to 2001–2004 for uterus, breast and certain other cancers. Conclusions: Obesity may contribute to about 6% of U.S. incident cancers, apparently has affected recent trends in incidence rates for certain cancers, and is important because of increasing prevalence in the U.S. population. [Copyright &y& Elsevier]

Although malignant tumors occur at all ages, cancer dispro- portionately strikes individuals in the age group 65 years and older. Data from the National Cancer Institute Surveil- lance, Epidemiology, and End Results Program for the most recent five-year period, 1998-2002, reveal that 56% of all newly diagnosed cancer patients and 71% of cancer deaths are in this age group. Median ages of cancer patients at death for the major tumors common to both males and fe- males, all races (lung, colorectal, lymphoma, leukemia, pan- creas, stomach, urinary bladder) range from 71 to 77 years. The median age for prostate cancer is 79 years; for ovarian and female breast cancer, the median age is 71 for each tumor. These cancer statistics when cast against the demo- graphic changes occurring in the U.S. population take on ur- gency and importance for cancer treatment and care in our nation's health care system. The U.S. Census Bureau dem- ographic projections indicate that the number of persons 65 years and older in the United States will double from the cur- rent estimate of 35 million persons to a projected 70 million by 2030. Barring any cancer prevention breakthroughs, the expansion of the aged population will likely increase the ab- solute number of older individuals diagnosed and treated for cancer in coming decades. The United States is not unique as an aging developed industrial nation with a high proportion of the cancer burden in the elderly. Other developed industrial countries have a potentiality for increased cancer incidence and mortality as their populations grow older. This paper, using U.S. Bureau of Census demographic projections and current age stan- dardized death rates per 100,000 population (from World- wide Cancer Mortality Statistics, Cancer Mondial, WHO, and the International Association for Research on Cancer) com- pares cancer in the elderly in Italy and the United States. Italy is demographically ranked as the oldest nation in the world. Dimensions of the cancer burden challenge ahead are inferred in the context of two countries with aging popu- lations to underscore the possible increase that demo- graphic factors may have on the magnitude of the cancer problem for older persons in the next 25 years. (Cancer J [ABSTRACT FROM AUTHOR]

Background: Monitoring mortality is a meaningful way to evaluate the effectiveness of cancer control activities. Results of trend analysis for cancer related deaths by race/ethnicity in California from 1970 to 1998 are reported here. Methods: Age-adjusted cancer mortality rates in California were used in the analysis of secular trends. Mortality patterns for selected cancers in all races combined are compared with similar patterns in the US for 1973–1998. Results: The overall cancer mortality rates in California began to decline in 1987 in both men and women. Although mortality trends by site, sex, and race/ethnicity showed significant variations, the overall pattern in California is heavily influenced by trends for the non-Hispanic white (NHW) population and is very similar to the patterns in the US with minor differences in the magnitude and trend. Conclusions: This is the first time that secular trends in cancer mortality for California are presented by race and ethnicity. Despite notable racial differences, the overall trend follows a declining pattern. Detailed explanation of the reasons behind the observed patterns is not included in this report. Some of the differences between California and the US, however, can be explained by differences in the racial and ethnic composition of the two populations. Approximately 45% of the California population has Hispanic (HSP) or Asian origins among whom cancer mortality rates are substantially lower. Another factor is the difference in the intensity and coverage of cancer related activities such as tobacco control. Prevalence of smoking in California is much lower than the rest of the US. [Copyright &y& Elsevier]