CANCER AND CHANGING TRENDS IN US MORTALITY INEQUITIES: 1960-2004

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DESCRIPTION (provided by applicant): Project Summary Debates exist as to whether, as overall population health improves, the absolute and relative magnitude of socioeconomic and racial/ethnic health disparities increases, stays the same, or decreases. These debates have profound policy implications, raising questions as to how societally-shaped ways of living, economic trends, policies, and priorities of public and private institutions in and outside the health sector shape population health. Notably, most research on trends in socioeconomic health inequities has focused on such outcomes as all-cause mortality, life expectancy, or infant mortality, with analyses typically extending back only to the 1980s. Evidence from cancer epidemiology and also our new study on "The fall and rise of US inequities in premature mortality: 1960-2002," however, indicates that cause-specific and temporal patterns in socioeconomic inequities in mortality, ESPECIALLY FOR CANCER, defy simple generalizations. We accordingly seek to test the overall hypothesis that socioeconomic inequities in CANCER mortality, over time, can variously widen, shrink, or stagnate, with different causes of death exhibiting different patterns. Building on our 1960-2002 national mortality database for US counties ranked by income level, our specific aims are thus: (a) Aim 1: enhance our secondary database by adding: (1) the 2003-2004 mortality data and harmonize the coding of cause-specific mortality (since codes span from ICD-7 to ICD-10) and (2) 1960-2000 COUNTY EDUCATIONAL AND MIGRATION DATA; (b) Aim 2: (1) calculate the 1960-2004 yearly age-standardized cause-specific mortality rates, BOTH OVERALL AND FOR PREMATURE MORTALITY FOR ALL-CAUSE AND SITE-SPECIFIC CANCER MORTALITY for each county income quintile, for the total population, overall and stratified by race/ethnicity, gender, and age; THE SITE-SPECIFIC ANALYSES WILL FOCUS ON: lung, colorectal, breast, prostate, cervix, stomach, AND liver CANCER [TEXT DELETED], AND (2) CREATE A DEATH CERTIFICATE QUALITY PROXY (DCQP) MEASURE, BASED ON THE COUNTY DATA FOR CANCER MORTALITY DUE TO ILL-DEFINED CANCERS, ALL- CAUSE MORTALITY DUE TO ILL-DEFINED CAUSES OF DEATH, AND MORTALITY DUE TO CAUSES OF DEATH PREVENTABLE BY MEDICAL INTERVENTION; (c) Aim 3: test the overall study hypothesis by analyzing the temporal patterning of socioeconomic inequities in cause-specific mortality for the specified population groups, TAKING INTO ACCOUNT THE DCPQ MEASURE AND COUNTY MIGRATION DATA, in relation to the following parameters: (i) relative and absolute inequity (incidence rate ratio (IRR) and difference (IRD)), (ii) change in slopes of the quintile-specific mortality rates and the IRR and IRD, and (iii) the population attributable fraction; and (d) Aim 4: Disseminate results by publishing scientific manuscripts and creating a website for the findings. The knowledge gained will: (a) set the basis for future research on the causes of the observed trends, and (b) aid efforts to eliminate socioeconomic and racial/health disparities, one of the overarching objectives of both Healthy People 2010 and the National Cancer Institute. PUBLIC HEALTH RELEVANCE: Relevance / Project Narrative Our objective is to conduct rigorous tests of the overall hypothesis that socioeconomic inequities in CANCER mortality, over time, can variously widen, shrink, or stagnate, with different causes of death exhibiting different patterns. Knowledge produced by the proposed study would be relevant to current efforts to improve population health and reduce health disparities, which are the two overarching goals of the US Department of Health and Human Services' Healthy People 2010 and inform the efforts of the National Institutes of Health and the National Cancer Institute to reduce and eliminate cancer- related and other health disparities.