title: Examining the association between socioeconomic status and potential human papillomavirus-associated cancers.
abstract: BACKGROUND
  This study examined the association between county-level measures of socioeconomic status (SES) and the incidence rate of human papillomavirus(HPV)-associated cancers, including cervical, vulvar, vaginal, anal, penile, and oral cavity and oropharyngeal cancers.
  
  
  METHODS
  The authors collected data from cancer registries for site-specific invasive cancer diagnoses between 1998 and 2003, inclusive, among adults aged >20 years at the time of diagnosis. County-level variables that included education, income, and poverty status were used as factors for socioeconomic status. Measures of rural-urban status, the percentage of the population that currently smoked, and the percentage of women who reported having ever had a Papanicolaou (Pap) test were also studied.
  
  
  RESULTS
  Lower education and higher poverty were found to be associated with increased penile, cervical, and vaginal invasive cancer incidence rates. Higher education was associated with increased incidence of vulvar cancer, male and female anal cancer, and male and female oral cavity and oropharyngeal cancers. Race was an independent predictor of the development of these potentially HPV-associated cancers.
  
  
  CONCLUSIONS
  These findings illustrate the association between SES variables and the development of HPV-associated cancers. The findings also highlight the importance of considering SES factors when developing policies to increase access to medical care and reduce cancer disparities in the United States.
authors.affiliation: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia 30341, USA. vdb9@cdc.gov
authors.forename: Vicki B
authors.initials: VB
authors.lastname: Benard
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Johnson
authors.forename: Trevor D
authors.initials: TD
authors.lastname: Thompson
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Roland
authors.forename: Sue Min
authors.initials: SM
authors.lastname: Lai
authors.forename: Vilma
authors.initials: V
authors.lastname: Cokkinides
authors.forename: Florence
authors.initials: F
authors.lastname: Tangka
authors.forename: Nikki A
authors.initials: NA
authors.lastname: Hawkins
authors.forename: Herschel
authors.initials: H
authors.lastname: Lawson
authors.forename: Hannah K
authors.initials: HK
authors.lastname: Weir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000821:virology*; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000150:complications*; D011203:Poverty; D044469:Racial Groups; D012042:Registries; D012307:Risk Factors; D012424:Rural Population; D012907:Smoking; D012923:Social Class; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D014626:Vaginal Smears