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County-level poverty and distant stage cancer in the United States

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Abstract

Objective

Late stage cancer at diagnosis increases the likelihood of cancer death. We evaluated the relation of county-level poverty with late stage cancer for 18 anatomic sites using data from the North American Association of Central Cancer Registries.

Methods

Stratified analysis and logistic regression were applied to 2 million incident cancers (1997–2000) from 32 states representing 57% of the United States.

Results

For 12 sites, higher county poverty significantly increased the odds of late stage, [adjusted odds ratio (95% confidence interval) comparing highest to lowest county poverty: larynx 2.4 (1.8–3.2), oral cavity 2.2 (1.8–2.7), melanoma 2.0 (1.5–2.8), female breast 1.9 (1.7–2.2), prostate 1.7 (1.5–1.9), corpus uteri 1.6 (1.3–1.9), cervix 1.6 (1.3–2.1), bladder 1.6 (1.2–2.1), colorectum 1.4 (1.3–1.5), esophagus 1.3 (1.1–1.7), stomach 1.3 (1.1–1.5), and kidney 1.3 (1.1–1.5)]. With some exceptions, county poverty associations with stage were comparable across gender and race, but stronger among metropolitan cases. A few differences by age may reflect screening patterns.

Conclusions

In this large population-based study, higher county poverty independently predicted distant stage cancer. This held for several non-screenable cancers, suggesting improved area economic deprivation, including access to and utilization of good medical care might facilitate earlier diagnosis and longer survival even for cancers without practical screening approaches.

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Abbreviations

CI:

Confidence interval

CINA:

Cancer in North America

NAACCR:

North American Association of Central Cancer Registries, Inc

NCI:

National Cancer Institute

NOS:

Not otherwise specified

OR:

Odds ratio

SEER:

Surveillance, Epidemiology, and End Results

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Acknowledgment

The authors would like to thank the staff of NAACCR, Inc. and IMS, Inc. for their work in generating CINA analytic files and the NAACCR scientific editorial board for their helpful suggestions.

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Correspondence to Robert T. Greenlee.

Additional information

Financial Support: Dr. Greenlee’s work on this project was supported by NAACCR subcontract 2004-07-03, to contract number N02-PC-35013-18 from NCI, and in-kind support from Marshfield Clinic Research Foundation. Its contents are solely the responsibility of the author and do not necessarily represent the official views of the National Cancer Institute.

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Greenlee, R.T., Howe, H.L. County-level poverty and distant stage cancer in the United States. Cancer Causes Control 20, 989–1000 (2009). https://doi.org/10.1007/s10552-009-9299-x

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