Area-level attributes and esophageal adenocarcinoma in surveillance, epidemiology and end results registries.
OBJECTIVE
To examine the associations between area-level socioeconomic attributes and stage of esophageal adenocarcinoma diagnoses in 16 SEER cancer registries during 2000-2007.


METHODS
Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression models to assess the relationship between distant-stage esophageal adenocarcinoma and individual, census tract, and county-level attributes.


RESULTS
Among cases with data on birthplace, no significant association was seen between reported birth within versus outside the United States and distant-stage cancer (adjusted OR=1.02, 95% CI: 0.85-1.22). Living in an area with a higher percentage of residents born outside the United States than the national average was associated with distant-stage esophageal adenocarcinoma; census tract level: >11.8%, (OR=1.10, 95% CI:1.01-1.19), county level: >11.8%, (OR=1.14, 95% CI:1.05-1.24). No association was observed between median household income and distant-stage cancer at either census tract or county levels.


CONCLUSIONS
The finding of greater odds of distant-stage esophageal adenocarcinoma among cases residing in SEER areas with higher proportion of non-U.S. Natives suggests local areas where esophageal cancer control efforts might be focused. Missing data at the individual level was a limitation of the present study. Furthermore, inconsistent associations with foreign birth at individual- versus area-levels cautions against using area-level attributes as proxies for case attributes.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America.
Armen A
AA
Ghazarian
Megan A
MA
Murphy
Maria R
MR
Khan
Brit I
BI
Saksvig
Sean F
SF
Altekruse
D000230:Adenocarcinoma / Q000453:epidemiology*; D004938:Esophageal Neoplasms / Q000453:epidemiology*; D006801:Humans; D012042:Registries / Q000706:statistics & numerical data*; D018426:SEER Program; D014481:United States