BACKGROUND: This is the first study to use the linked National Longitudinal Mortality Study and Surveillance, Epidemiology, and End Results (SEER) data to determine the effects of individual-level socioeconomic factors (health insurance, education, income, and poverty status) on racial disparities in receiving treatment and in survival. METHODS: This study included 13,234 cases diagnosed with the 8 most common types of cancer (female breast, colorectal, prostate, lung and bronchus, uterine cervix, ovarian, melanoma, and urinary bladder) at age ≥ 25 years, identified from the National Longitudinal Mortality Study-SEER data during 1973 to 2003. Kaplan-Meier methods and Cox regression models were used for survival analysis. RESULTS: Three-year all-cause observed survival for cases diagnosed with local-stage cancers of the 8 leading tumors combined was ≥ 82% regardless of race/ethnicity. More favorable survival was associated with higher socioeconomic status. Compared with whites, blacks were less likely to receive first-course cancer-directed surgery, perhaps reflecting a less favorable stage distribution at diagnosis. Hazard ratio (HR) for cancer-specific mortality was significantly higher among blacks compared with whites (HR, 1.2; 95% confidence interval [CI], 1.1-1.3) after adjusting for age, sex, and tumor stage, but not after further controlling for socioeconomic factors and treatment (HR, 1.0; 95% CI, 0.9-1.1). HRs for all-cause mortality among patients with breast cancer and for cancer-specific mortality in patients with prostate cancer were significantly higher for blacks compared with whites after adjusting for socioeconomic factors, treatment, and patient and tumor characteristics. CONCLUSIONS: Favorable survival was associated with higher socioeconomic status. Racial disparities in survival persisted after adjusting for individual-level socioeconomic factors and treatment for patients with breast and prostate cancer.
BACKGROUND: This is the first study to use the linked National Longitudinal Mortality Study and Surveillance, Epidemiology, and End Results (SEER) data to determine the effects of individual-level socioeconomic factors (health insurance, education, income, and poverty status) on racial disparities in receiving treatment and in survival. METHODS: This study included 13,234 cases diagnosed with the 8 most common types of cancer (female breast, colorectal, prostate, lung and bronchus, uterine cervix, ovarian, melanoma, and urinary bladder) at age ≥ 25 years, identified from the National Longitudinal Mortality Study-SEER data during 1973 to 2003. Kaplan-Meier methods and Cox regression models were used for survival analysis. RESULTS: Three-year all-cause observed survival for cases diagnosed with local-stage cancers of the 8 leading tumors combined was ≥ 82% regardless of race/ethnicity. More favorable survival was associated with higher socioeconomic status. Compared with whites, blacks were less likely to receive first-course cancer-directed surgery, perhaps reflecting a less favorable stage distribution at diagnosis. Hazard ratio (HR) for cancer-specific mortality was significantly higher among blacks compared with whites (HR, 1.2; 95% confidence interval [CI], 1.1-1.3) after adjusting for age, sex, and tumor stage, but not after further controlling for socioeconomic factors and treatment (HR, 1.0; 95% CI, 0.9-1.1). HRs for all-cause mortality among patients with breast cancer and for cancer-specific mortality in patients with prostate cancer were significantly higher for blacks compared with whites after adjusting for socioeconomic factors, treatment, and patient and tumor characteristics. CONCLUSIONS: Favorable survival was associated with higher socioeconomic status. Racial disparities in survival persisted after adjusting for individual-level socioeconomic factors and treatment for patients with breast and prostate cancer.
Authors: Lisa A Newman; Kent A Griffith; Ismail Jatoi; Michael S Simon; Joseph P Crowe; Graham A Colditz Journal: J Clin Oncol Date: 2006-03-20 Impact factor: 44.544
Authors: Limin X Clegg; Marsha E Reichman; Benjamin F Hankey; Barry A Miller; Yi D Lin; Norman J Johnson; Stephen M Schwartz; Leslie Bernstein; Vivien W Chen; Marc T Goodman; Scarlett L Gomez; John J Graff; Charles F Lynch; Charles C Lin; Brenda K Edwards Journal: Cancer Causes Control Date: 2007-01-11 Impact factor: 2.506
Authors: Manuel A Molina; Michael C Cheung; Eduardo A Perez; Margaret M Byrne; Dido Franceschi; Frederick L Moffat; Alan S Livingstone; W Jarrard Goodwin; Juan C Gutierrez; Leonidas G Koniaris Journal: Cancer Date: 2008-11-15 Impact factor: 6.860
Authors: Anna V Wilkinson; Vandita Vasudevan; Susan E Honn; Margaret R Spitz; Robert M Chamberlain Journal: J Cancer Educ Date: 2009 Impact factor: 2.037
Authors: Limin X Clegg; Marsha E Reichman; Barry A Miller; Benjamin F Hankey; Gopal K Singh; Yi Dan Lin; Marc T Goodman; Charles F Lynch; Stephen M Schwartz; Vivien W Chen; Leslie Bernstein; Scarlett L Gomez; John J Graff; Charles C Lin; Norman J Johnson; Brenda K Edwards Journal: Cancer Causes Control Date: 2008-11-12 Impact factor: 2.506
Authors: Ninez A Ponce; Jennifer Tsui; Sara J Knight; Aimee Afable-Munsuz; Uri Ladabaum; Robert A Hiatt; Jennifer S Haas Journal: Cancer Date: 2011-08-25 Impact factor: 6.860
Authors: Jill K Schinkel; Stephanie Shao; Shelia H Zahm; Katherine A McGlynn; Craig D Shriver; Kangmin Zhu Journal: Cancer Epidemiol Date: 2016-05-06 Impact factor: 2.984
Authors: Kelsey L Corrigan; Leticia Nogueira; K Robin Yabroff; Chun Chieh Lin; Xuesong Han; Junzo P Chino; Anna E Coghill; Meredith Shiels; Ahmedin Jemal; Gita Suneja Journal: Cancer Date: 2019-11-11 Impact factor: 6.860
Authors: Carlos J Rodriguez; Zhezhen Jin; Joseph E Schwartz; Daniel Turner-Lloveras; Ralph L Sacco; Marco R Di Tullio; Shunichi Homma Journal: Am J Hypertens Date: 2013-01-31 Impact factor: 2.689
Authors: Norma E Farrow; Selena J An; Paul J Speicher; David H Harpole; Thomas A D'Amico; Jacob A Klapper; Matthew G Hartwig; Betty C Tong Journal: J Thorac Cardiovasc Surg Date: 2019-11-13 Impact factor: 5.209
Authors: Elke J A H van Beek; Jonathan M Hernandez; Debra A Goldman; Jeremy L Davis; Kaitlin McLaughlin; R Taylor Ripley; Teresa S Kim; Laura H Tang; Jaclyn F Hechtman; Jian Zheng; Marinela Capanu; Nikolaus Schultz; David M Hyman; Marc Ladanyi; Michael F Berger; David B Solit; Yelena Y Janjigian; Vivian E Strong Journal: Ann Surg Oncol Date: 2018-05-03 Impact factor: 5.344
Authors: Steven K M Lau; Bhavani S Gannavarapu; Kristen Carter; Ang Gao; Chul Ahn; Jeffrey J Meyer; David J Sher; Aminah Jatoi; Rodney Infante; Puneeth Iyengar Journal: J Oncol Pract Date: 2018-03-20 Impact factor: 3.840
Authors: Jennifer L Beebe-Dimmer; Terrance L Albrecht; Tara E Baird; Julie J Ruterbusch; Theresa Hastert; Felicity W K Harper; Michael S Simon; Judith Abrams; Kendra L Schwartz; Ann G Schwartz Journal: Cancer Epidemiol Biomarkers Prev Date: 2018-11-27 Impact factor: 4.254