Area Socioeconomic Variations in U.S. Cancer Incidence, Mortality, Stage, Treatment, and Survival, 1975–1999

Foreword

This monograph presents one of the most comprehensive analyses yet on socioeconomic patterns in cancer incidence and outcomes in the United States. The extensive amount of data assembled in this report will be extremely useful in furthering our understanding of the relationship of socioeconomic status to the overall cancer burden as well as to the magnitude and causes of current social inequalities in cancer between major racial and ethnic groups in the United States. Documenting and monitoring the extent of socioeconomic inequalities in cancer incidence, mortality, disease stage, treatment, and survival remain central to cancer surveillance research in terms of generating hypotheses for population health research and the evidence for comprehensive population-based strategies for cancer prevention and control. This monograph is an excellent example of how linkage of census-based area measures with the national mortality and SEER databases can be used to track socioeconomic trends in cancer rates and to improve our capacity to monitor progress toward reducing the cancer burden among various segments of the U.S. population.

Disparities documented here are not necessarily the experience of each individual. Rather, they indicate differences in cancer incidence and outcomes among population groups or geographic areas that are stratified with respect to key social and economic resources, such as education, income, or poverty level. These group- or area-based differences in cancer may be related to a variety of factors, including the social and physical environment, health behaviors (smoking and diet being two main cancer-related behaviors), and health care.

This monograph also makes a significant contribution to the burgeoning literature on social determinants of health. Although the role of socioeconomic factors as determinants of such major chronic diseases as heart disease, stroke, diabetes, and respiratory diseases are well established, their relationship with cancer is less well studied. As shown here, the relationship between socioeconomic position and cancer is a complex one and varies according to cancer type and secular time. Despite overall improvements in mortality and patient survival, socioeconomic inequalities in cancer persist, but in some instances they may be changing direction, lessening or widening over time. Like other diseases and health outcomes, differences in cancer incidence, mortality, disease stage, and survival are shown to exist across the entire range of social hierarchy, not just between rich and poor, privileged and disadvantaged. It is hoped that the data and findings of this report will stimulate future research aimed at identifying major social, environmental, health care, behavioral, and biologic determinants underlying these cancer disparities.

I would like to congratulate my former colleagues at the National Cancer Institute for completing this important work, which highlights the value of the SEER program as a national resource. It is an exciting example of the kinds of results we can expect from an expanded perspective on what can be accomplished by surveillance research. I, with the authors, hope that this publication will be a major stimulus for innovative work by cancer researchers, novel insights by policy makers, and ultimately improvement of the public health.