title: Health care access and poverty do not explain the higher esophageal cancer mortality in African Americans.
abstract: BACKGROUND
  Esophageal cancer mortality is increased in African Americans relative to white patients. The reasons for this are unknown but are thought to be related to inadequate access to health care secondary to a higher poverty rate in African American populations.
  
  
  METHODS
  The National Health Interview Survey database for years 1986 to 1994 were combined and linked to the National Death Index. Individuals who died from esophageal carcinoma were assessed in the combined database, thus enabling detailed analysis of their socioeconomic status, race, and health care access.
  
  
  RESULTS
  Poverty was 4-fold more frequent in African Americans who died from esophageal carcinoma than whites. Despite poverty, African American patients' access to health care was good and was not statistically related to increased mortality.
  
  
  CONCLUSIONS
  Although the esophageal carcinoma mortality rate is higher in African Americans than in whites, it is not clearly related to the presence of poverty or to limited health care access. The higher mortality may be related to lifestyle differences, environmental exposure, or difference in disease biology, but it is not related exclusively to socioeconomic factors.
authors.affiliation: Division of Gastrointestinal and Endocrine Surgery, University of Texas Southwestern School of Medicine, 5323 Harry Hines Blvd., Room E7-126, Dallas, TX 75390-9156, USA.
authors.forename: Jordan A G
authors.initials: JA
authors.lastname: Miller
authors.forename: Robert V
authors.initials: RV
authors.lastname: Rege
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
authors.forename: Edward H
authors.initials: EH
authors.lastname: Livingston
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D016208:Databases, Factual / Q000706:statistics & numerical data; D004938:Esophageal Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000517:prevention & control; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D008297:Male; D011203:Poverty / Q000208:ethnology*; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data