Changing area socioeconomic pattern in U.S. cancer mortality, 1950-1998

Part I - All cancers among men

Gopal K. Singh, Barry A. Miller, Benjamin F. Hankey, Eric J. Feuer, Linda Williams Pickle

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

Background: Area socioeconomic deprivation indices are widely used to monitor health disparities in Europe. However, such indices have not been used in cancer surveillance in the United States. We developed an area socioeconomic index to examine area socioeconomic patterns in all-cancer mortality among U.S. men between 1950 and 1998. Methods: Principal components analysis on 11 census variables was used to develop an area socioeconomic index that was then used to stratify all U.S. counties into one of five socioeconomic categories. The index was linked to 1950-1998 county mortality data to generate annual mortality rates for each area socioeconomic group. Joinpoint regression analysis was used to model mortality trends, and Poisson regression analysis was used to estimate socioeconomic gradients in mortality over time. Results: Area socioeconomic patterns in U.S. male cancer mortality changed dramatically between 1950 and 1998. Throughout the 1950s and 1960s, there was a positive socioeconomic gradient, with higher cancer mortality rates in high area socioeconomic groups than in low area socioeconomic groups. For example, in 1950-1952, cancer mortality was 49% (95% confidence interval [CI] = 41% to 59%) greater in the highest area socioeconomic group than in the lowest. The positive gradient narrowed in the 1970s, and by the late 1980s, socioeconomic differences in cancer mortality began to reverse and widen. In 1997-1998, cancer mortality was 19% (95% CI = 11% to 28%) higher in the lowest area socioeconomic group than in the highest. Gradients were steeper for men aged 25-64 years than for men aged 65 years or older. Conclusions: Socioeconomic patterns in male cancer mortality have reversed over time in the United States. Area socioeconomic indices could serve as a powerful surveillance tool for monitoring health disparities in cancer outcomes.

Original languageEnglish (US)
Pages (from-to)904-915
Number of pages12
JournalJournal of the National Cancer Institute
Volume94
Issue number12
StatePublished - Jun 19 2002

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Mortality
Neoplasms
Regression Analysis
Confidence Intervals
Health
Censuses
Principal Component Analysis

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Singh, G. K., Miller, B. A., Hankey, B. F., Feuer, E. J., & Pickle, L. W. (2002). Changing area socioeconomic pattern in U.S. cancer mortality, 1950-1998: Part I - All cancers among men. Journal of the National Cancer Institute, 94(12), 904-915.
Singh, Gopal K. ; Miller, Barry A. ; Hankey, Benjamin F. ; Feuer, Eric J. ; Pickle, Linda Williams. / Changing area socioeconomic pattern in U.S. cancer mortality, 1950-1998 : Part I - All cancers among men. In: Journal of the National Cancer Institute. 2002 ; Vol. 94, No. 12. pp. 904-915.
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abstract = "Background: Area socioeconomic deprivation indices are widely used to monitor health disparities in Europe. However, such indices have not been used in cancer surveillance in the United States. We developed an area socioeconomic index to examine area socioeconomic patterns in all-cancer mortality among U.S. men between 1950 and 1998. Methods: Principal components analysis on 11 census variables was used to develop an area socioeconomic index that was then used to stratify all U.S. counties into one of five socioeconomic categories. The index was linked to 1950-1998 county mortality data to generate annual mortality rates for each area socioeconomic group. Joinpoint regression analysis was used to model mortality trends, and Poisson regression analysis was used to estimate socioeconomic gradients in mortality over time. Results: Area socioeconomic patterns in U.S. male cancer mortality changed dramatically between 1950 and 1998. Throughout the 1950s and 1960s, there was a positive socioeconomic gradient, with higher cancer mortality rates in high area socioeconomic groups than in low area socioeconomic groups. For example, in 1950-1952, cancer mortality was 49{\%} (95{\%} confidence interval [CI] = 41{\%} to 59{\%}) greater in the highest area socioeconomic group than in the lowest. The positive gradient narrowed in the 1970s, and by the late 1980s, socioeconomic differences in cancer mortality began to reverse and widen. In 1997-1998, cancer mortality was 19{\%} (95{\%} CI = 11{\%} to 28{\%}) higher in the lowest area socioeconomic group than in the highest. Gradients were steeper for men aged 25-64 years than for men aged 65 years or older. Conclusions: Socioeconomic patterns in male cancer mortality have reversed over time in the United States. Area socioeconomic indices could serve as a powerful surveillance tool for monitoring health disparities in cancer outcomes.",
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Singh, GK, Miller, BA, Hankey, BF, Feuer, EJ & Pickle, LW 2002, 'Changing area socioeconomic pattern in U.S. cancer mortality, 1950-1998: Part I - All cancers among men', Journal of the National Cancer Institute, vol. 94, no. 12, pp. 904-915.

Changing area socioeconomic pattern in U.S. cancer mortality, 1950-1998 : Part I - All cancers among men. / Singh, Gopal K.; Miller, Barry A.; Hankey, Benjamin F.; Feuer, Eric J.; Pickle, Linda Williams.

In: Journal of the National Cancer Institute, Vol. 94, No. 12, 19.06.2002, p. 904-915.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Changing area socioeconomic pattern in U.S. cancer mortality, 1950-1998

T2 - Part I - All cancers among men

AU - Singh, Gopal K.

AU - Miller, Barry A.

AU - Hankey, Benjamin F.

AU - Feuer, Eric J.

AU - Pickle, Linda Williams

PY - 2002/6/19

Y1 - 2002/6/19

N2 - Background: Area socioeconomic deprivation indices are widely used to monitor health disparities in Europe. However, such indices have not been used in cancer surveillance in the United States. We developed an area socioeconomic index to examine area socioeconomic patterns in all-cancer mortality among U.S. men between 1950 and 1998. Methods: Principal components analysis on 11 census variables was used to develop an area socioeconomic index that was then used to stratify all U.S. counties into one of five socioeconomic categories. The index was linked to 1950-1998 county mortality data to generate annual mortality rates for each area socioeconomic group. Joinpoint regression analysis was used to model mortality trends, and Poisson regression analysis was used to estimate socioeconomic gradients in mortality over time. Results: Area socioeconomic patterns in U.S. male cancer mortality changed dramatically between 1950 and 1998. Throughout the 1950s and 1960s, there was a positive socioeconomic gradient, with higher cancer mortality rates in high area socioeconomic groups than in low area socioeconomic groups. For example, in 1950-1952, cancer mortality was 49% (95% confidence interval [CI] = 41% to 59%) greater in the highest area socioeconomic group than in the lowest. The positive gradient narrowed in the 1970s, and by the late 1980s, socioeconomic differences in cancer mortality began to reverse and widen. In 1997-1998, cancer mortality was 19% (95% CI = 11% to 28%) higher in the lowest area socioeconomic group than in the highest. Gradients were steeper for men aged 25-64 years than for men aged 65 years or older. Conclusions: Socioeconomic patterns in male cancer mortality have reversed over time in the United States. Area socioeconomic indices could serve as a powerful surveillance tool for monitoring health disparities in cancer outcomes.

AB - Background: Area socioeconomic deprivation indices are widely used to monitor health disparities in Europe. However, such indices have not been used in cancer surveillance in the United States. We developed an area socioeconomic index to examine area socioeconomic patterns in all-cancer mortality among U.S. men between 1950 and 1998. Methods: Principal components analysis on 11 census variables was used to develop an area socioeconomic index that was then used to stratify all U.S. counties into one of five socioeconomic categories. The index was linked to 1950-1998 county mortality data to generate annual mortality rates for each area socioeconomic group. Joinpoint regression analysis was used to model mortality trends, and Poisson regression analysis was used to estimate socioeconomic gradients in mortality over time. Results: Area socioeconomic patterns in U.S. male cancer mortality changed dramatically between 1950 and 1998. Throughout the 1950s and 1960s, there was a positive socioeconomic gradient, with higher cancer mortality rates in high area socioeconomic groups than in low area socioeconomic groups. For example, in 1950-1952, cancer mortality was 49% (95% confidence interval [CI] = 41% to 59%) greater in the highest area socioeconomic group than in the lowest. The positive gradient narrowed in the 1970s, and by the late 1980s, socioeconomic differences in cancer mortality began to reverse and widen. In 1997-1998, cancer mortality was 19% (95% CI = 11% to 28%) higher in the lowest area socioeconomic group than in the highest. Gradients were steeper for men aged 25-64 years than for men aged 65 years or older. Conclusions: Socioeconomic patterns in male cancer mortality have reversed over time in the United States. Area socioeconomic indices could serve as a powerful surveillance tool for monitoring health disparities in cancer outcomes.

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M3 - Article

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