County-level poverty and distant stage cancer in the United States.
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.
Greenlee
Robert T
RT
Marshfield Clinic Research Foundation, 1000 North Oak Ave., Mailstop ML2, Marshfield, WI 54449, USA. greenlee.robert@mcrf.mfldclin.edu
Howe
Holly L
HL
D016001:Confidence Intervals; D055088:Early Detection of Cancer; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology*; D016017:Odds Ratio; D011203:Poverty; D012042:Registries; D012923:Social Class; D015996:Survival Rate; D014481:United States / Q000453:epidemiology