Scarlett Lin Gomez1,2,3, Alison J Canchola4, David O Nelson4,5,6, Theresa H M Keegan7, Christina A Clarke4,5,6, Iona Cheng4,6, Salma Shariff-Marco4,5,6, Mindy DeRouen4, Ralph Catalano8, William A Satariano8, Kathleen Davidson-Allen4, Sally L Glaser4,5,6. 1. Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA. scarlett@cpic.org. 2. Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA. scarlett@cpic.org. 3. Stanford Cancer Institute, Stanford, USA. scarlett@cpic.org. 4. Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94536, USA. 5. Department of Health Research & Policy (Epidemiology), School of Medicine, Stanford, CA, USA. 6. Stanford Cancer Institute, Stanford, USA. 7. Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA, USA. 8. School of Public Health, University of California, Berkeley, CA, USA.
Abstract
PURPOSE: In recent years, cancer case counts in the U.S. underwent a large, rapid decline-an unexpected change given population growth for older persons at highest cancer risk. As these declines coincided with the Great Recession, we examined whether they were related to economic conditions. METHODS: Using California Cancer Registry data from California's 30 most populous counties, we analyzed trends in cancer incidence during pre-recession (1996-2007) and recession/recovery (2008-2012) periods for all cancers combined and the ten most common sites. We evaluated the recession's association with rates using a multifactorial index that measured recession impact, and modeled associations between case counts and county-level unemployment rates using Poisson regression. RESULTS: Yearly cancer incidence rate declines were greater during the recession/recovery (3.3% among males, 1.4% among females) than before (0.7 and 0.5%, respectively), particularly for prostate, lung, and colorectal cancers. Lower case counts, especially for prostate and liver cancer among males and breast cancer, melanoma, and ovarian cancer among females, were associated with higher unemployment rates, irrespective of time period, but independent of secular effects. The associations for melanoma translated up to a 3.6% decrease in cases with each 1% increase in unemployment. Incidence declines were not greater in counties with higher recession impact index. CONCLUSIONS: Although recent declines in incidence of certain cancers are not differentially impacted by economic conditions related to the Great Recession relative to pre-recession conditions, the large recent absolute declines in the case counts of some cancer may be attributable to the large declines in unemployment in the recessionary period. This may occur through decreased engagement in preventive health behaviors, particularly for clinically less urgent cancers. Continued monitoring of trends is important to detect any rises in incidence rates as deferred diagnoses come to clinical attention.
PURPOSE: In recent years, cancer case counts in the U.S. underwent a large, rapid decline-an unexpected change given population growth for older persons at highest cancer risk. As these declines coincided with the Great Recession, we examined whether they were related to economic conditions. METHODS: Using California Cancer Registry data from California's 30 most populous counties, we analyzed trends in cancer incidence during pre-recession (1996-2007) and recession/recovery (2008-2012) periods for all cancers combined and the ten most common sites. We evaluated the recession's association with rates using a multifactorial index that measured recession impact, and modeled associations between case counts and county-level unemployment rates using Poisson regression. RESULTS: Yearly cancer incidence rate declines were greater during the recession/recovery (3.3% among males, 1.4% among females) than before (0.7 and 0.5%, respectively), particularly for prostate, lung, and colorectal cancers. Lower case counts, especially for prostate and liver cancer among males and breast cancer, melanoma, and ovarian cancer among females, were associated with higher unemployment rates, irrespective of time period, but independent of secular effects. The associations for melanoma translated up to a 3.6% decrease in cases with each 1% increase in unemployment. Incidence declines were not greater in counties with higher recession impact index. CONCLUSIONS: Although recent declines in incidence of certain cancers are not differentially impacted by economic conditions related to the Great Recession relative to pre-recession conditions, the large recent absolute declines in the case counts of some cancer may be attributable to the large declines in unemployment in the recessionary period. This may occur through decreased engagement in preventive health behaviors, particularly for clinically less urgent cancers. Continued monitoring of trends is important to detect any rises in incidence rates as deferred diagnoses come to clinical attention.
Entities:
Keywords:
Case counts; Economy; Recession; Unemployment
Authors: Balazs I Bodai; Therese E Nakata; William T Wong; Dawn R Clark; Steven Lawenda; Christine Tsou; Raymond Liu; Linda Shiue; Neil Cooper; Michael Rehbein; Benjamin P Ha; Anne Mckeirnan; Rajiv Misquitta; Pankaj Vij; Andrew Klonecke; Carmelo S Mejia; Emil Dionysian; Sean Hashmi; Michael Greger; Scott Stoll; Thomas M Campbell Journal: Perm J Date: 2018