Holowatyj Andreana N, Liu Lili, Munro Heather M, Perkins-Smith Julia J, Han Xijing, Kolitsopoulos Francesca, Shrubsole Martha J, Lipworth Loren, Russo Leo J, Zheng Wei
Vanderbilt University Medical Center, Nashville, Tennessee, United States.
Vanderbilt University, United States.
Cancer Epidemiol Biomarkers Prev. 2025 Aug 11. doi: 10.1158/1055-9965.EPI-24-1161.
Race and income are social factors that contribute to persistent inequities in cancer care delivery/outcomes. However, cancer disparities patterns within underserved populations-such as those with annual household income (AHI)<$15,000-remain incompletely understood. We evaluated survival among low-income Americans who identified as Black or White with breast, prostate, lung, or colorectal cancer.
Using the Southern Community Cohort Study prospectively-collected data and linkages to state cancer registries and National Death Index, we identified adults with primary breast, prostate, lung or colorectal cancer. Cox proportional hazards models were used to compare race-specific overall survival among individuals by AHI.
A total of 4,651 individuals who self-identified as Black or White were diagnosed with breast (n=1,223), prostate (n=1,158), lung (n=1,469) or colorectal (n=801) cancer. Over half (56.8%) reported AHI<$15,000. Specific to those reporting AHI<$15,000, Black individuals with lung cancer had a significantly lower hazard of death than Whites after adjustment for age, sex, surgery, clinical stage, smoking history, lung cancer subtype, BMI, COPD, persistent poverty, enrollment year and source (HR=0.78; 95%CI=0.66-0.92). In contrast, Black females with AHI<$15,000 had a slightly higher hazard of death than Whites for breast cancer (HR=1.20; 95%CI=0.85-1.70), although these differences were not statistically significant. No racial differences were observed for prostate or colorectal cancers.
Among individuals with AHI<$15,000, racial disparities in survival were observed for lung, but not other, cancers.
Disentangling the interplay of race and individual-level income on cancer survival guides improved access to high-quality cancer care services, which could reduce inequities and improve clinical outcomes.
种族和收入是导致癌症治疗/结果持续存在不平等现象的社会因素。然而，在服务不足的人群中，如家庭年收入（AHI）低于15,000美元的人群，癌症差异模式仍未完全了解。我们评估了被认定为黑人或白人且患有乳腺癌、前列腺癌、肺癌或结直肠癌的低收入美国人的生存率。
利用南方社区队列研究前瞻性收集的数据以及与州癌症登记处和国家死亡指数的关联，我们确定了患有原发性乳腺癌、前列腺癌、肺癌或结直肠癌的成年人。采用Cox比例风险模型按AHI比较不同种族的总体生存率。
共有4651名自认为是黑人或白人的个体被诊断患有乳腺癌（n = 1223）、前列腺癌（n = 1158）、肺癌（n = 1469）或结直肠癌（n = 801）。超过一半（56.8%）的人报告AHI低于15,000美元。对于报告AHI低于15,000美元的人群，在调整年龄、性别、手术、临床分期、吸烟史、肺癌亚型、体重指数、慢性阻塞性肺疾病、长期贫困、入组年份和来源后，患有肺癌的黑人个体的死亡风险显著低于白人（风险比[HR]=0.78；95%置信区间[CI]=0.66 - 0.92）。相比之下，AHI低于15,000美元的黑人女性患乳腺癌的死亡风险略高于白人（HR = 1.20；95%CI = 0.85 - 1.70），尽管这些差异无统计学意义。前列腺癌或结直肠癌未观察到种族差异。
在AHI低于15,000美元的个体中，肺癌存在生存方面的种族差异，而其他癌症则没有。
理清种族与个体层面收入对癌症生存情况的相互作用，有助于改善获得高质量癌症护理服务的机会，从而减少不平等现象并改善临床结果。
