While cancer death rates have decreased overall in the U.S., substantial disparities exist among counties. To examine the factors that may drive these disparities, Dr. Jeremy O'Connor, who conducted the research while he was a National Clinician Scholar at Yale School of Medicine, analyzed publicly available data documenting cancer mortality rates by county (JAMA Network Open, October 5, 2018).
He and his colleagues compared the rates in low-, medium-, and high-income counties using death records from the National Center for Health Statistics in 2014, with data collected and analyzed between October 1, 2016, and July 31, 2017. All 3,135 U.S. counties and county equivalents were included. Using a method known as mediation analysis, they identified factors that were associated with the disparities.
There are significant county-level disparities in cancer deaths, they found, ranging from 186 deaths per 100,000 persons in high-income counties to 230 deaths per 100,000 persons in low-income counties.
Most of the disparities could be explained by a small number of key factors: food insecurity, smoking, physical inactivity, and the quality of healthcare provided in the counties.
"The paper suggests all of these factors are interplaying to lead to disparities," O'Connor said in a release from Yale. "It's not just health behaviors or quality of care; it's all of the factors together."
The study also underscores the fact that while overall cancer death rates are affected by advances in cancer treatment, much of the disparities in death rates might be attributable to issues outside of treatment, such as smoking and obesity, the researchers noted.
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