Poverty and Cancer Disparities in Ohio

John Kollman, MS; Holly L. Sobotka, MS

Disclosures

Prev Chronic Dis. 2018;15(12):E152 

In This Article

Results

Approximately 320,000 new invasive cancer cases were diagnosed in Ohio from 2011 through 2015; 24,588 cases were in the 12 poorest counties and 30,229 cases were in the 10 most affluent counties. During the same period, more than 126,000 deaths in Ohio were caused by cancer: 10,319 cancer deaths in the poorest counties and 10,571 cancer deaths in the most affluent counties.

Cancer Incidence

The incidence rate of all cancers combined was 464.0 per 100,000 in the poorest counties and 461.3 per 100,000 in the most affluent counties. The incidence rate was significantly higher in the poorest counties than in the most affluent counties for the following cancers: cervix (9.5 vs 5.4 per 100,000 women), larynx (4.6 vs 3.3 per 100,000), esophagus (6.0 vs 4.5 per 100,000), liver and intrahepatic bile duct (7.1 vs 5.7 per 100,000), lung and bronchus (74.9 vs 62.1 per 100,000), oral cavity and pharynx (12.5 vs 10.5 per 100,000), and colon and rectum (44.9 vs 39.8 per 100,000) (Figure 1). The most affluent counties had significantly higher incidence rates for melanoma of the skin, thyroid cancer, non-Hodgkin lymphoma, ovarian cancer, female breast cancer and prostate cancer. The incidence rate for cervical cancer in the poorest counties was 1.8 times higher than the rate in the most affluent counties.

Figure 1.

Ratios comparing cancer incidence rates in the 12 poorest counties with cancer incidence rates in the 10 most affluent counties in Ohio, by site or type of cancer, 2011–2015. Rates are per 100,000, age-adjusted to the 2000 US standard population and sex-specific for breast, cervix, ovary, prostate, testis, and uterus. Types of cancer were categorized according to the conventions of the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program (11). Source of data on incidence: Ohio Department of Health (9).

Cancer Mortality

The mortality rate for all cancers combined was 19% higher in the poorest counties (192.2 per 100,000) than in the most affluent counties (161.9 per 100,000). In addition, the mortality rate was significantly higher in the poorest counties for the following sites or types of cancers: larynx (1.8 vs 0.8 per 100,000), cervix (3.6 vs 1.6 per 100,000 women, oral cavity and pharynx (3.2 vs 2.3 per 100,000), liver and intrahepatic bile duct (6.6 vs 4.8 per 100,000), colon and rectum (18.0 vs 13.4 per 100,000), prostate (20.5 vs 16.0 per 100,000 men), and lung and bronchus (56.9 vs 44.6 per 100,000) (Figure 2). The greatest difference in mortality between the poorest counties and the most affluent counties was for cervical cancer and laryngeal cancer. The cervical cancer mortality rate in the poorest counties was 2.3 times the rate in the most affluent counties. The laryngeal cancer mortality rate in the poorest counties was 2.3 times the rate in the most affluent counties. We found no cancers for which the mortality rate was significantly higher in the most affluent group.

Figure 2.

Ratios comparing cancer mortality rates in the 12 poorest counties with cancer mortality rates in the 10 most affluent counties in Ohio, by site or type of cancer, 2011–2015. Rates are per 100,000, age-adjusted to the 2000 US standard population and sex-specific for breast, cervix, ovary, prostate, testis, and uterus. Types of cancer were categorized according to the conventions of the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program (11). Source of data on mortality: Ohio Department of Health (13).

Stage at Diagnosis

A greater percentage of several cancers (cervix, colon and rectum, larynx, oral cavity and pharynx, lung and bronchus, and all cancers combined) was diagnosed at a late stage in the poorest counties than in the most affluent counties (Table 1). The percentage of cervical cancers diagnosed at a late stage was significantly different between the 2 types of counties: 60.0% in the poorest counties and 45.1% in the most affluent counties. We found a significantly higher percentage in the poorest counties than in the most affluent counties of cases that were unstaged or had missing information on stage for lung and bronchus cancer and all cancers combined.

Cancer Risk Factors

The prevalence of current smoking, obesity, and physical inactivity was significantly higher in the poorest counties than in the most affluent counties (Table 2): 25.6% versus 17.1% for current smoking, 32.7% versus 28.3% for obesity, and 29.7% versus 23.0% for physical inactivity. The prevalence of heavy drinking in the poorest counties (5.6%) was similar to the prevalence in the most affluent counties (5.5%). During 2011–2015 (excluding 2013), the percentage of women aged 21 to 65 who reported having had a Pap test within the last 3 years was similar in the poorest counties (75.0%) and the most affluent counties (75.2%).

Health Insurance Status

A significantly higher percentage of people with cancer in the poorest counties, compared with people with cancer in the most affluent counties, were uninsured (2.7% vs 1.9%), had Medicaid (8.3% vs 3.5%), had Medicare (47.7% vs 45.1%), or had military or Veterans Affairs (VA) benefits (1.6% vs 1.0%) (Table 3). The poorest counties had a significantly higher proportion of cases in which health insurance status was unknown (6.7% vs 5.7%). The most affluent counties had a significantly higher percentage of people whose primary payer at diagnosis was private insurance (42.9% vs 33.0%).

Treatment Status

A significantly smaller percentage of people were given treatment in the poorest counties (81.0%) than in the most affluent counties (82.9%) (Table 3). The percentage of cervical cancer cases in which no treatment was given was 9.6% in the poorest counties and 4.9% in the most affluent counties, although this difference was not significant. About 6% of all cancer treatment was reported as unknown in both the poorest and most affluent counties, and we found no significant difference for this variable between the 2 groups.

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