New SEER monograph

[niton@mchsi.com]

I thought this new monograph may be of interest in light of past discussions 

concerning ecologic radon studies and socioeconomic factors.



 "Area Socioeconomic Variations in US Cancer Incidence, Mortality, Stage, 

Treatment, and Survival, 1975-1999."  



Staff primarily responsible for this publication are Gopal Singh and Barry 

Miller.  



Hard copies will be available in the near future.  The monograph has been 

posted to the SEER Web site and is also listed under New Reports on the SRP 

Web site. 



<http://seer.cancer.gov/publications/ses/> 



<http://surveillance.cancer.gov>



Some of the findings indicate that socioeconomic relationships to disease 

change substantially over time and caution must be used when assigning a 

static correction which is commonplace in the ecologic radon studies that were 

discussed on this list.



 Lung Cancer Findings



• The higher the county poverty rate, the greater the lung cancer mortality 

rate among U.S. men. However, area socioeconomic gradients in lung cancer 

mortality among U.S. men widened between 1975 and 1999. Compared to the rate 

for men in low poverty counties, the lung cancer mortality rate for U.S. men 

in high poverty counties was 7% greater in 1975 and 25% greater in 1999.



• Lung cancer incidence during 1988–1992 increased with increasing census 

tract poverty rate for non-Hispanic white and black men and women and 

Asian/Pacific Islander (API) men.



In contrast, for Hispanic men and women, lung cancer incidence rates were 

higher in low poverty census tracts than in high poverty census tracts.



The major behavioral, environmental, and health care determinants of cancer, 

such as smoking, diet, alcohol use, reproductive behavior, occupational and 

environmental exposures, and cancer screening are themselves substantially 

influenced by individual-and area-level socioeconomic factors.



Trends in Mortality

Area socioeconomic gradients in lung cancer mortality among U.S. men increased 

between 1975 and 1999 compared to the rate for men in low poverty areas, the 

lung cancer mortality rate for U.S. men in high poverty areas was 7% greater in

1975 and 25% greater in 1999.  Temporal socioeconomic patterns in male lung 

cancer mortality in the SEER regions differed from those for the U.S. as a 

whole. The differential in the mortality rates between the low and high 

poverty areas in the SEER regions remained stable throughout 1975–1999, with 

men in high poverty areas experiencing at least 18% higher mortality than men 

in low poverty areas.



In 1975, U.S. women in high poverty areas had a 7% lower lung cancer mortality 

rate than those in low poverty areas. But the area socioeconomic differences 

diminished in the 1990s, and the 1999 data indicate no statistically 

significant differentials between the area poverty groups (Figure 3.13, page 

39).  Temporal socioeconomic patterns in female lung cancer mortality in the 

SEER regions, however, differed from those for the U.S. as a whole. The rate 

was highest in the counties with poverty rates exceeding 20%, followed by 

counties with poverty rates less than 10%, with counties with poverty levels 

between 10% and 20% having the lowest rates.



Cross-Sectional Patterns in Mortality

During 1995–1999, lung cancer mortality among U.S. men increased with 

increasing area poverty rates for non-Hispanic whites, blacks, and Hispanics, 

but did not change significantly with poverty rates for APIs.  The lung cancer 

mortality rates were respectively 16%, 29%, and 56% higher for black, non-

Hispanic white, and Hispanic men in high poverty areas than in low poverty 

areas.  During 1995–1999, area socioeconomic gradients in U.S. lung cancer 

mortality among women differed by race/ethnicity.  Compared to the rates for 

their counterparts in low poverty areas, the lung cancer mortality rates for 

non-Hispanic white women and Hispanic women were respectively 6% and 29% 

higher in high poverty areas. The rates for API and American Indian/Alaska 

native women were respectively 26% and 24% lower in high poverty areas than in 

low poverty areas.



Trends in Incidence

Trends in male lung cancer incidence were similar to the SEER mortality 

trends, with the incidence rate for men in high poverty counties during 1975–

1999 being at least 12% greater than the rate for men in low poverty counties. 

Trends in female lung cancer incidence were also similar to the SEER mortality 

trends, with the incidence rate for women in high poverty counties during 1975–

1999 being at least 11% greater than the rate for women in counties with 

poverty levels between 10% and 20%.



Cross-Sectional Patterns in Incidence

The area socioeconomic gradient in SEER lung cancer incidence during 1988–1992 

was steeper for men than for women.  The lung cancer incidence rate increased 

with increasing area (census tract) poverty rate for non-Hispanic white and 

black men and women and API men.  Compared to the rates for their counterparts 

in low poverty areas, the lung cancer incidence rates for non-Hispanic white, 

black, and API men were respectively 45%, 46%, and 23% higher in high poverty 

areas. The incidence rates for non-Hispanic white and black women were 

respectively 23% and 19% higher in high poverty areas than in low poverty 

areas. In contrast, for Hispanic men and women, lung cancer incidence rates 

were respectively 21% and 34% higher in low poverty areas than in high poverty 

areas.











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