1356P - Socioeconomic vulnerabilities (SEV) and cancer-related mortality in United States (US): A cross-sectional analysis

Background

Cancer is the second leading cause of death. Social vulnerabilities are known to be associated with worse health outcomes. However, the association of cancer mortality with underlying SEV is unexplored.

Methods

Percentile ranking scores (PRS) were calculated for each US county using social vulnerability indices from agency for toxic substances and disease registry (ATSDR). PRS (ranging from 0-1) were then categorized into quartiles (Q: 1^st: 0-0.25 [least vulnerable]; 4^th:0.75-1.00 [most vulnerable]). County level age adjusted mortality rates (AAMR) per 100,000 person-years (PY) were extracted for leading causes of cancer deaths (lung/bronchus, colon/rectal, hepatobiliary, pancreas, breast, ovary, and prostate) from wide ranging online data for epidemiological research (WONDER) database and were linked with quartile rankings. Rate ratios (RR) of AAMRs between 4^th and 1^st Q were then estimated with 95% confidence intervals using population weighted, poission regression.

Results

Data from 3060 US counties were included in this analysis. The overall cancer related AAMR per 100,000 PY was 128.9. A stepwise increase was observed in AAMRs from the 1^st to 4^th Q (114.5 vs 141.5) for overall cancers. AAMRs were significantly higher in counties in 4^th Q for hepatobiliary, (RR: 1.52, [95% CI: 1.45-1.61]), colorectal (1.21 [1.16-1.26]), breast (1.11 [1.07-1.15]) and prostate cancers (1.19 [1.14-1.24]) as compared to AAMRs in the 1^st Q. No significant differences were observed for other cancers. Significantly higher AAMRs were observed in 4^th Q as compared to 1^st Q in patients <65 years (premature mortality) for all cancers (1.31 [1.20-1.42]). AAMRs of Hispanic patients with lung (1.31 [1.14-1.51]), colorectal (1.48 [1.28-1.72]), pancreatic (1.25 [1.10-1.43]), and hepatobiliary cancers (1.44 [1.20-1.73]) were significantly higher in 4^th Q compared to 1^st Q. Similar results were observed for non-Hispanic Black patients with lung, colorectal and hepatobiliary cancer.

Conclusions

There may be an increased risk of premature cancer mortality in socioeconomically vulnerable US counties. Similar investigations should be done globally to understand the impact of SEV on cancer mortality across different regions of the world.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Syed Arsalan Ahmed Naqvi.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.