title: Impact of socioeconomic status on cancer incidence and stage at diagnosis: selected findings from the surveillance, epidemiology, and end results: National Longitudinal Mortality Study.
abstract: BACKGROUND
  Population-based cancer registry data from the Surveillance, Epidemiology, and End Results (SEER) Program at the National Cancer Institute (NCI) are mainly based on medical records and administrative information. Individual-level socioeconomic data are not routinely reported by cancer registries in the United States because they are not available in patient hospital records. The U.S. representative National Longitudinal Mortality Study (NLMS) data provide self-reported, detailed demographic and socioeconomic data from the Social and Economic Supplement to the Census Bureau's Current Population Survey (CPS). In 1999, the NCI initiated the SEER-NLMS study, linking the population-based SEER cancer registry data to NLMS data. The SEER-NLMS data provide a new unique research resource that is valuable for health disparity research on cancer burden. We describe the design, methods, and limitations of this data set. We also present findings on cancer-related health disparities according to individual-level socioeconomic status (SES) and demographic characteristics for all cancers combined and for cancers of the lung, breast, prostate, cervix, and melanoma.
  
  
  METHODS
  Records of cancer patients diagnosed in 1973-2001 when residing 1 of 11 SEER registries were linked with 26 NLMS cohorts. The total number of SEER matched cancer patients that were also members of an NLMS cohort was 26,844. Of these 26,844 matched patients, 11,464 were included in the incidence analyses and 15,357 in the late-stage diagnosis analyses. Matched patients (used in the incidence analyses) and unmatched patients were compared by age group, sex, race, ethnicity, residence area, year of diagnosis, and cancer anatomic site. Cohort-based age-adjusted cancer incidence rates were computed. The impact of socioeconomic status on cancer incidence and stage of diagnosis was evaluated.
  
  
  RESULTS
  Men and women with less than a high school education had elevated lung cancer rate ratios of 3.01 and 2.02, respectively, relative to their college educated counterparts. Those with family annual incomes less than $12,500 had incidence rates that were more than 1.7 times the lung cancer incidence rate of those with incomes $50,000 or higher. Lower income was also associated with a statistically significantly increased risk of distant-stage breast cancer among women and distant-stage prostate cancer among men.
  
  
  CONCLUSIONS
  Socioeconomic patterns in incidence varied for specific cancers, while such patterns for stage were generally consistent across cancers, with late-stage diagnoses being associated with lower SES. These findings illustrate the potential for analyzing disparities in cancer outcomes according to a variety of individual-level socioeconomic, demographic, and health care characteristics, as well as by area measures available in the linked database.
authors.affiliation: Office of Healthcare Inspections, Office of Inspector General (54AA), U.S. Department of Veterans Affairs, 810 Vermont Ave., NW, Washington, DC 20420, USA. Lin.Clegg@va.gov
authors.forename: Limin X
authors.initials: LX
authors.lastname: Clegg
authors.forename: Marsha E
authors.initials: ME
authors.lastname: Reichman
authors.forename: Barry A
authors.initials: BA
authors.lastname: Miller
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Hankey
authors.forename: Gopal K
authors.initials: GK
authors.lastname: Singh
authors.forename: Yi Dan
authors.initials: YD
authors.lastname: Lin
authors.forename: Marc T
authors.initials: MT
authors.lastname: Goodman
authors.forename: Charles F
authors.initials: CF
authors.lastname: Lynch
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schwartz
authors.forename: Vivien W
authors.initials: VW
authors.lastname: Chen
authors.forename: Leslie
authors.initials: L
authors.lastname: Bernstein
authors.forename: Scarlett L
authors.initials: SL
authors.lastname: Gomez
authors.forename: John J
authors.initials: JJ
authors.lastname: Graff
authors.forename: Charles C
authors.initials: CC
authors.lastname: Lin
authors.forename: Norman J
authors.initials: NJ
authors.lastname: Johnson
authors.forename: Brenda K
authors.initials: BK
authors.lastname: Edwards
mesh_terms: D001943:Breast Neoplasms / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality / Q000473:pathology; D015331:Cohort Studies; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality / Q000473:pathology; D008297:Male; D008498:Medical Record Linkage; D008545:Melanoma / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D009369:Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality* / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality / Q000473:pathology; D012042:Registries; D018426:SEER Program; D012923:Social Class; D017741:Survivors / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality / Q000473:pathology