Income, race and survival among low-income Black and White Americans with lung, breast, prostate or colorectal cancer.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

Among individuals with AHI<$15,000, racial disparities in survival were observed for lung, but not other, cancers.

IMPACT

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.