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PurposeWhile cancer mortality has declined by 27% between 1991 and 2016 in the United States, there are large disparities in cancer mortality by racial/ethnic groups, socioeconomic status and access to care. The purpose of this analysis is to compare trends in cancer mortality among regions (Service Planning Areas, SPAs) in Los Angeles (LA) County that vary with respect to racial/ethnic distribution and social determinants of health, including poverty, education and access to care.MethodsWe estimated age- and race/ethnicity-standardized mortality for lung, colorectal (CRC) and breast cancer for eight SPAs from 1999 to 2013. We calculated three recommended measures of disparities that reflect absolute, relative and between-group disparities.ResultsIn all of LA County, statistically significant declines in age- and race/ethnicity-standardized mortality ranged from 30% for lung cancer to 20% for CRC to 15% for breast cancer. Despite some of the largest declines in the most under-resourced SPAs (South LA, East LA, South Bay), disparities between the lowest and highest mortality by SPA did not significantly change from 1999 to 2013.ConclusionsDespite significant declines in cancer mortality in LA County from 1999 to 2013, and in racial/ethnic groups, there was little progress toward reducing disparities among SPAs. Highest mortalities for the three cancers were observed in Antelope Valley, San Fernando Valley, San Gabriel Valley, South LA and East LA. Findings demonstrate the importance of examining regional differences in cancer mortality to identify areas with highest needs for interventions and policies to reduce cancer disparities.

Abstract: Variance function regression models and demographic decomposition methods are applied to identify two dimensions of changes in health disparities (SES-demographic effects vs. compositional effects, between-group disparities vs. within-group disparities) in the US from 1984 to 2007. Using National Health Interview Survey data on self-reported health, we find that disparities in men’s health increased, while those of women decreased, for the whole period. Widening men’s health disparities are largely driven by increases in the effects of SES-demographic statuses on within-group disparities. These increases are moderated by increasing levels of men’s college attainment. But decreasing middle and upper income attainment and a decreasing employment rate further increase men’s health disparities. For women, the effects of SES-demographic statuses on health disparities also increased over time. This, however, was outweighed by increases in women’s college attainment, middle and upper income attainment, and employment rate. The result is overall declining self-reported health disparities for women. [Copyright &y& Elsevier]