title: Correlation of the ratio of metastatic to non-metastatic cancer cases with the degree of socioeconomic deprivation among Texas counties.
abstract: BACKGROUND
  Previous studies have demonstrated that cancer registrations and hospital discharge rate are closely correlated with census data-based socioeconomic deprivation indices. We hypothesized that communities with higher degrees of socioeconomic deprivation tend to have a higher ratio of metastatic to non-metastatic cancer cases (lung, breast, prostate, female genital system, colorectal cancers or all types of cancers combined). In this study, we investigate the potential link between this ratio and the Wellbeing Index (WI) among Texas counties.
  
  
  RESULTS
  Cancer data in 2000 were provided by the Texas Cancer Registry, while data on the ten socioeconomic variables among the 254 Texas counties in 2000 for building the WI were obtained from U.S. Census Bureau. The ten socioeconomic status variables were subjected to the principal component analysis, and the first principal component scores were grouped into deciles for the WI (1 to 10) and the 254 Texas counties were classified into 10 corresponding groups. Weighted linear regression analyses and a Cochran-Armitage trend test were performed to determine the relationship between the ratio of age-adjusted metastatic to non-metastatic cancer incidence cases and WI. The ratios of metastatic to non-metastatic cases of female genital system cancer (r2 = 0.84, p = 0.0002), all-type cancers (r2= 0.73, p = 0.0017) and lung cancer (r2= 0.54, p = 0.0156) at diagnosis were positively correlated with WI.
  
  
  CONCLUSIONS
  The ratios of metastatic to non-metastatic cases of all-type, female genital system and lung cancers at diagnosis were statistically correlated with socioeconomic deprivation. Potential mediators for the correlation warrant further investigation in order to reduce health disparities associated with socioeconomic inequality.
authors.affiliation: F, Marie Hall Institute for Rural Community Health, Texas Tech University Health Science Center, Lubbock, Texas 79430, USA. billy.philips@ttuhsc.edu
authors.forename: Billy U
authors.initials: BU
authors.lastname: Philips
authors.forename: Gordon
authors.initials: G
authors.lastname: Gong
authors.forename: Kristopher A
authors.initials: KA
authors.lastname: Hargrave
authors.forename: Eric
authors.initials: E
authors.lastname: Belasco
authors.forename: Conrad P
authors.initials: CP
authors.lastname: Lyford
mesh_terms: D005260:Female; D005833:Genital Neoplasms, Female / Q000191:economics / Q000453:epidemiology / Q000473:pathology; D054624:Health Status Disparities; D006305:Health Status Indicators; D006801:Humans; D016014:Linear Models; D008175:Lung Neoplasms / Q000191:economics / Q000453:epidemiology / Q000473:pathology; D008297:Male; D009026:Mortality; D009362:Neoplasm Metastasis / Q000473:pathology; D009369:Neoplasms / Q000191:economics / Q000453:epidemiology* / Q000473:pathology; D011203:Poverty / Q000191:economics / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods; D012959:Socioeconomic Factors; D013781:Texas / Q000453:epidemiology