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Age-adjusted mortality rates (AAMRs) associated with cancer appeared to be higher in US counties demonstrating higher social vulnerability, according to the results of a recent study. Results were reported in the journal The Oncologist.
“In this nationwide study, we demonstrate concerning trends where the most socially vulnerable US counties have higher cancer mortality rates than the least vulnerable US counties with significant sociodemographic and disease-site variation,” the study investigators wrote in their report.
The cross-sectional study examined cancer-related mortality patterns across the US based on county-level social vulnerability. County-level social vulnerability was estimated using a measure called the Social Vulnerability Index (SVI), which combines 15 factors related to categories of socioeconomic status, household composition and disability, minority status and language, and type of housing and transportation. SVI data were obtained from the US Centers for Disease Control and Prevention (CDC) Agency for Toxic Substances and Disease Registry.
Cancer-related mortality data were obtained from the CDC Wide-ranging Online Data for Epidemiological Research database. AAMRs were evaluated for counties considered the least and most vulnerable, with counties categorized into 4 groups by SVI level.
The overall AAMR estimated in this study was 173 deaths per 100,000 individuals, reflecting 4,107,273 fatalities overall. AAMRs were found to be highest in certain population subgroups, including adults above 65 years of age, men, non-Hispanic Black individuals, and populations from rural and Southern counties.
AAMRs were higher for the most vulnerable counties, compared with the least vulnerable counties (rate ratio [RR], 1.09; 95% CI, 1.08-1.10). In comparisons of most and least vulnerable counties, disparities in mortality risk were especially high for certain subgroups. These included individuals in Southern (RR, 1.17; 95% CI, 1.16-1.19) and rural (RR, 1.17; 95% CI, 1.15-1.19) counties, among individuals who were aged 45 to 65 years (RR, 1.23; 95% CI, 1.21-1.25), and for Hispanic individuals (RR, 1.11; 95% CI, 1.06-1.16).
Disparities by cancer type across the most and least vulnerable counties were highest with lung (RR, 1.17; 95% CI, 1.15-1.19) and colorectal (RR, 1.15; 95% CI, 1.13-1.17) cancers. Patients with lung and colorectal cancers appeared impacted by vulnerable socioeconomic status and household barriers. Housing and transportation also appeared to impact patients with colorectal cancer or prostate cancer.
“As vulnerable counties bear greatest burdens in cancer mortality, our study provides a valuable metric in SVI that may assist state- and federal-level deliberations of invested funds in achieving geographic parity across socially disinvested counties,” the study investigators stated in their report. They also noted that some counties do not have reported cancer deaths for some patient subgroups, which can limit some comparisons.
Reference
Chen KY, Blackford AM, Sedhom R, Gupta A, Hussaini SMQ. Local social vulnerability as a predictor for cancer-related mortality among US counties. Oncologist. Published online June 19, 2023. doi:10.1093/oncolo/oyad176
