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Contribution of health behaviors to the association between area-level socioeconomic status and cancer mortality

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  • Hastert, Theresa A.
  • Ruterbusch, Julie J.
  • Beresford, Shirley A.A.
  • Sheppard, Lianne
  • White, Emily

Abstract

Cancer mortality is higher among residents of low-socioeconomic status (SES) areas than those of high-SES areas; however, the contribution of modifiable risk factors to this disparity is not known. We used data from 54,737 participants in the VITamins And Lifestyle (VITAL) Study, aged 50–76 with no history of cancer at baseline (2000–2002). Of these, 1488 died of cancer over an average of 7.7 years of follow-up. Data on modifiable risk factors including body mass index (BMI), physical activity, diet, alcohol, smoking and screening were taken from baseline questionnaires. We constructed a block group-level SES index using data from the 2000 United States Census and fit Cox proportional hazards models estimating the association between area-level SES and total cancer mortality with and without control for modifiable risk factors. All statistical tests are 2-sided. Cancer mortality was 77% (95% CI: 50%, 111%) higher in the lowest-SES areas compared with the highest. Modifiable risk factors accounted for 45% (95% CI: 34%, 62%) of this association. Smoking explained the greatest proportion (29%; 95% CI: 22%, 40%) of the observed association, followed by diet (11%; 95% CI: 7%, 17%), physical activity (10%; 95% CI: 7%, 16%), screening (9%; 6%, 13%), and BMI (5%; 95% CI: 1%, 10%). Results were similar in models controlling for individual education and income. The association between area-level SES and cancer mortality is partially explained by modifiable risk factors, which could suggest the appropriate targets to reduce socioeconomic disparities.

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  • Hastert, Theresa A. & Ruterbusch, Julie J. & Beresford, Shirley A.A. & Sheppard, Lianne & White, Emily, 2016. "Contribution of health behaviors to the association between area-level socioeconomic status and cancer mortality," Social Science & Medicine, Elsevier, vol. 148(C), pages 52-58.
    • Handle: RePEc:eee:socmed:v:148:y:2016:i:c:p:52-58
    DOI: 10.1016/j.socscimed.2015.11.023
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    2. Elham Khodayari Moez & Katerina Maximova & Shannon Sim & Ambikaipakan Senthilselvan & Roman Pabayo, 2022. "Developing a Socioeconomic Status Index for Chronic Disease Prevention Research in Canada," IJERPH, MDPI, vol. 19(13), pages 1-13, June.
    3. Wei-Yin Kuo & Han-Sheng Hsu & Pei-Tseng Kung & Wen-Chen Tsai, 2021. "Impact of Socioeconomic Status on Cancer Incidence Risk, Cancer Staging, and Survival of Patients with Colorectal Cancer under Universal Health Insurance Coverage in Taiwan," IJERPH, MDPI, vol. 18(22), pages 1-17, November.
    4. Paolo Giorgi Rossi & Olivera Djuric & Simone Navarra & Alessandra Rossi & Anteo Di Napoli & Luisa Frova & Alessio Petrelli, 2020. "Geographic Inequalities in Breast Cancer in Italy: Trend Analysis of Mortality and Risk Factors," IJERPH, MDPI, vol. 17(11), pages 1-14, June.
    5. Angel G. Ortiz & Daniel Wiese & Kristen A. Sorice & Minhhuyen Nguyen & Evelyn T. González & Kevin A. Henry & Shannon M. Lynch, 2020. "Liver Cancer Incidence and Area-Level Geographic Disparities in Pennsylvania—A Geo-Additive Approach," IJERPH, MDPI, vol. 17(20), pages 1-20, October.

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