Record Details

Title County-level poverty and distant stage cancer in the United States
Author Greenlee, RT
Secondary Authors Howe HL
Publication Type (Help) article
Journal Cancer Causes Control
Month Aug
Year 2009
Pages 989-1000
Volume 20
Number 6
Note doi: 10.1007/s10552-009-9299-x
PubMed ID 19199061
EPub Date 2009 Feb 07
Citation Greenlee RT, Howe HL. County-level poverty and distant stage cancer in the United States. Cancer Causes Control. 2009 Aug;20(6):989-1000. EPub 2009 Feb 07. PMID 19199061. []


Late stage cancer at diagnosis increases the likelihood of cancer death. The relation of county-level poverty with late stage cancer for 18 anatomic sites was evaluated using data from NAACCR. Stratified analysis and logistic regression were applied to 2 million incident cancers (1997-2000) from 32 states representing 57% of the United States. For 12 sites, higher county poverty significantly increased the odds of late stage [adjusted odds ratio (95% confidence interval), comparing highest to lowest county poverty: larynx 2.4 (1.8-3.2), oral cavity 2.2 (1.8-2.7), melanoma 2.0 (1.5-2.8), female breast 1.9 (1.7-2.2), prostate 1.7 (1.5-1.9), corpus uteri 1.6 (1.3-1.9), cervix 1.6 (1.3-2.1), bladder 1.6 (1.2-2.1), colorectum 1.4 (1.3-1.5), esophagus 1.3 (1.1-1.7), stomach 1.3 (1.1-1.5), and kidney 1.3 (1.1-1.5)]. With some exceptions, county poverty associations with stage were comparable across gender and race, but stronger among metropolitan cases. A few differences by age may reflect screening patterns. In this large population-based study, higher county poverty independently predicted distant stage cancer. This held for several non-screenable cancers, suggesting improved area economic deprivation, including access to and utilization of good medical care, might facilitate earlier diagnosis and longer survival even for cancers without practical screening approaches.


distant stage
united states