title: The relationship between cancer incidence, stage and poverty in the United States.
abstract: We extend a prior analysis on the relation between poverty and cancer incidence in a sample of 2.90 million cancers diagnosed in 16 US states plus Los Angeles over the 2005-2009 period by additionally considering stage at diagnosis. Recognizing that higher relative disparities are often found among less-common cancer sites, our analysis incorporated both relative and absolute measures of disparities. Fourteen of the 21 cancer sites analyzed were found to have significant variation by stage; in each instance, diagnosis at distant stage was more likely among residents of high-poverty areas. If the incidence rates found in the lowest-poverty areas for these 21 cancer sites were applied to the entire country, 18,000 fewer distant-stage diagnoses per year would be expected, a reduction of 8%. Conversely, 49,000 additional local-stage diagnoses per year would be expected, an increase of 4%. These figures, strongly influenced by the most common sites of prostate and female breast, speak to the trade-offs inherent in cancer screening. Integrating the type of analysis presented here into routine cancer surveillance activities would permit a more complete understanding of the dynamic nature of the relationship between socioeconomic status and cancer incidence.
authors.affiliation: New York State Department of Health, New York State Cancer Registry, Albany, NY.
authors.forename: Francis P
authors.initials: FP
authors.lastname: Boscoe
authors.affiliation: Department of Geography and Urban Studies, Temple University, Philadelphia, PA.|Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Henry
authors.affiliation: North American Association of Central Cancer Registries, Springfield, IL.
authors.forename: Recinda L
authors.initials: RL
authors.lastname: Sherman
authors.affiliation: Cancer Data Registry of Idaho, Boise, ID.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Johnson
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D016017:Odds Ratio; D011203:Poverty; D012042:Registries; D014481:United States / Q000453:epidemiology
keywords: cancer incidence; disparities; socioeconomic status