Poverty and Cancer Disparities in Ohio

John Kollman, MS; Holly L. Sobotka, MS


Prev Chronic Dis. 2018;15(12):E152 

In This Article


Cancer affects all population groups in the United States; however, certain groups bear a disproportionate burden of cancer. Cancer-related disparities are differences between groups of people in cancer incidence, mortality, and stage or in risk factors associated with cancer, such as tobacco use or lack of access to cancer screening. People with lower socioeconomic status have higher cancer death rates than those with higher socioeconomic status, regardless of demographic factors such as race/ethnicity.[1] The National Cancer Institute reports that many factors can cause cancer disparities, including poverty and a resultant lack of high-quality medical care.[2]

The relationship between socioeconomic status and cancer incidence and mortality in the United States is well established,[3–5] and it varies according to cancer site or type.[5] Cancers associated with poor areas in the United States include cancers of the lung and bronchus, colon and rectum, cervix, oral cavity and pharynx, and liver and intrahepatic bile duct.[3] Cancers associated with more affluent areas in the United States include cancers of the breast, prostate, and thyroid and melanoma of the skin.[3] One study using US data found that rates for some cancers differed by as much as a factor of 2 between the poorest groups and the most affluent groups.[3] Residents of poor areas are also more likely than residents of wealthier areas to receive a diagnosis cancer at a late stage.[4]

We examined cancer disparities in Ohio to determine whether the relationship between poverty and cancer was apparent at the county level. Ohio is suitable for such an analysis because the state's poverty rates vary by county, ranging from 4.5% to 33.0%, such that poor counties are mostly in the Appalachian region of Ohio and the more affluent counties are mostly suburban and do not include metropolitan areas. The objective of this study was to describe differences in cancer incidence and mortality rates, stage at diagnosis, cancer risk factors, health insurance status, and treatment status between the poorest counties and the most affluent counties in Ohio.