title: Cancer mortality-to-incidence ratios in Georgia: describing racial cancer disparities and potential geographic determinants.
abstract: BACKGROUND
  The objective of this study was to evaluate racial cancer disparities in Georgia by calculating and comparing mortality-to-incidence ratios (MIRs) by health district and in relation to geographic factors.
  
  
  METHODS
  Data sources included cancer incidence (Georgia Comprehensive Cancer Registry), cancer mortality (Georgia Vital Records), and health factor (County Health Rankings) data. Age-adjusted incidence and mortality rates were calculated by cancer site (all sites combined, lung, colorectal, prostate, breast, oral, and cervical) for 2003-2007. MIRs and 95% confidence intervals were calculated overall and by district for each cancer site, race, and sex. MIRs were mapped by district and compared with geographic health factors.
  
  
  RESULTS
  In total, 186,419 incident cases and 71,533 deaths were identified. Blacks had higher MIRs than whites for every cancer site evaluated, and especially large differentials were observed for prostate, cervical, and oral cancer in men. Large geographic disparities were detected, with larger MIRs, chiefly among blacks, in Georgia compared with national data. The highest MIRs were detected in west and east central Georgia, and the lowest MIRs were detected in and around Atlanta. Districts with better health behavior, clinical care, and social/economic factors had lower MIRs, especially among whites.
  
  
  CONCLUSIONS
  More fatal cancers, particularly prostate, cervical, and oral cancer in men were detected among blacks, especially in central Georgia, where health behavior and social/economic factors were worse. MIRs are an efficient indicator of survival and provide insight into racial cancer disparities. Additional examination of geographic determinants of cancer fatality in Georgia as indicated by MIRs is warranted.
authors.affiliation: College of Public Health, Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia 30602-7396, USA. swagner@uga.edu
authors.forename: Sara E
authors.initials: SE
authors.lastname: Wagner
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Hurley
authors.forename: James R
authors.initials: JR
authors.lastname: Hébert
authors.forename: Chrissy
authors.initials: C
authors.lastname: McNamara
authors.forename: A Rana
authors.initials: AR
authors.lastname: Bayakly
authors.forename: John E
authors.initials: JE
authors.lastname: Vena
mesh_terms: D044383:Black People; D004777:Environment; D005006:Ethnicity; D005260:Female; D005845:Georgia; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008297:Male; D009369:Neoplasms / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality; D012959:Socioeconomic Factors; D044465:White People; D001741:Black or African American