Changing Area Socioeconomic Patterns in U.S. Cancer Mortality, 1950-1998: Part I--All Cancers Among Men

BACKGROUND: Area socioeconomic deprivation indices are widely used to monitor health disparities in Europe. However, such indices have not been used in cancer surveillance in the United States. We developed an area socioeconomic index to examine area socioeconomic patterns in all-cancer mortality among U.S. men between 1950 and 1998. METHODS: Principal components analysis on 11 census variables was used to develop an area socioeconomic index that was then used to stratify all U.S. counties into one of five socioeconomic categories. The index was linked to 1950-1998 county mortality data to generate annual mortality rates for each area socioeconomic group. Joinpoint regression analysis was used to model mortality trends, and Poisson regression analysis was used to estimate socioeconomic gradients in mortality over time. RESULTS: Area socioeconomic patterns in U.S. male cancer mortality changed dramatically between 1950 and 1998. Throughout the 1950s and 1960s, there was a positive socioeconomic gradient, with higher cancer mortality rates in high area socioeconomic groups than in low area socioeconomic groups. For example, in 1950-1952, cancer mortality was 49% (95% confidence interval CI = 41% to 59%) greater in the highest area socioeconomic group than in the lowest. The positive gradient narrowed in the 1970s, and by the late 1980s, socioeconomic differences in cancer mortality began to reverse and widen. In 1997-1998, cancer mortality was 19% (95% CI = 11% to 28%) higher in the lowest area socioeconomic group than in the highest. Gradients were steeper for men aged 25-64 years than for men aged 65 years or older. CONCLUSIONS: Socioeconomic patterns in male cancer mortality have reversed over time in the United States. Area socioeconomic indices could serve as a powerful surveillance tool for monitoring health disparities in cancer outcomes.