Intersectionality of Race, Rurality on Persistent Poverty Disparities in Cancer Mortality in Alabama

IF 3.5 2区医学 Q2 ONCOLOGY

Cancer Medicine Pub Date : 2026-09-30 DOI:10.1002/cam4.72333

Mackenzie E. Fowler, Hayden D. Reeves, Suzanne Judd, Kelley Pettee Gabriel, Geetanjali Saini, Mahak Bhargava, Timiya S. Nolan, Ritu Aneja

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引用次数: 0

Abstract

Introduction

Counties in persistent poverty (PP) have higher cancer-related mortality rates. Intersectionality with race and rurality is present; individuals identifying as Black residing in rural PP counties have the highest cancer-related mortality rates. However, heterogeneity exists throughout counties (e.g., demographics). To date, few studies evaluated the effect of small-area PP residence on individual-level survival and intersectionality with race and rurality.

Methods

This retrospective cohort utilized Alabama Statewide Cancer Registry data of adults with breast, prostate, colorectal, or lung cancer. The exposure was NCI-designated 2010 census tract-level PP (tracts with ≥ 20% population below poverty line for ≥ 30 years) at diagnosis and the outcome was overall survival from date of diagnosis to death or end of follow-up. Associations were estimated via sequential Cox proportional hazards models first with PP as the only predictor then adjusting for demographics (age, race, sex [colorectal, lung]), demographics plus clinical characteristics (stage, subtype [breast], and first course treatment), and finally demographics, clinical characteristics, and social determinants (rurality, insurance status). We also performed a decomposition analysis of the association between PP and survival through race and rurality.

Results

In the fully adjusted model, living in a PP-tract was associated with higher risk of death among those with breast (hazard ratio [95% CI]: 1.18 [1.09–1.27]), prostate (1.21 [1.11–1.31]), and lung cancer (1.09 [1.05–1.14]) compared to living in a non-PP-tract. Race and rurality were independently associated with higher risk of death across cancers. Individuals identifying as Black residing in a rural PP-tract had the highest magnitude of risk for all cancers.

Conclusions

Living in a PP-tract is associated with higher risk of death among patients with breast, prostate, and lung cancer in Alabama. This association is complicated by race and rurality. Multilevel interventions tailored to local context may help overcome adverse effects of social characteristics on cancer outcomes.

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种族的交叉性，农村对阿拉巴马州癌症死亡率持续贫困差异的影响。

导言：持续贫困县（PP）的癌症相关死亡率较高。存在与种族和乡村性的交叉性；居住在农村PP县的黑人具有最高的癌症相关死亡率。然而，各个国家存在着异质性（例如，人口统计）。迄今为止，很少有研究评估小面积PP居住对个体水平生存的影响以及与种族和乡村性的交叉性。方法：这一回顾性队列研究利用了阿拉巴马州癌症登记处的乳腺癌、前列腺癌、结直肠癌或肺癌的成人数据。诊断时暴露为nci指定的2010年人口普查区水平PP（≥20%人口低于贫困线且≥30年的地区），结果为从诊断之日到死亡或随访结束的总生存期。通过顺序Cox比例风险模型估计相关性，首先将PP作为唯一的预测因子，然后调整人口统计学（年龄、种族、性别[结直肠、肺]）、人口统计学加临床特征（分期、亚型[乳房]和首个治疗），最后调整人口统计学、临床特征和社会决定因素（农村性、保险状况）。我们还通过种族和乡村性对PP与生存之间的关系进行了分解分析。结果：在完全调整后的模型中，与生活在非PP-tract中的患者相比，生活在PP-tract中的患者死亡风险更高（风险比[95% CI]: 1.18[1.09-1.27]），前列腺癌（1.21[1.11-1.31]）和肺癌（1.09[1.05-1.14]）。种族和农村与癌症死亡风险的增加独立相关。居住在农村PP-tract的黑人个体患所有癌症的风险最高。结论：在阿拉巴马州，生活在pp -道的乳腺癌、前列腺癌和肺癌患者的死亡风险较高。这种联系因种族和乡村性而变得复杂。针对当地情况量身定制的多层次干预可能有助于克服社会特征对癌症结果的不利影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.