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Socioeconomic gradients in cancer incidence by race and ethnicity in California, 2008–2012: the influence of tobacco use or screening detectable cancers

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Abstract

Purpose

There are clearly documented inequalities in cancer incidence by socioeconomic position, but it is unclear whether this is due primarily to differences in tobacco exposure and screening practices or to other factors.

Methods

Our study included 741,373 incident cases of invasive cancer from 2008 to 2012 in California. We calculated age-standardized incidence rates across twelve categories of census tract poverty as a measure of socioeconomic position (SEP) for (1) all cancer sites combined, (2) sites not strongly related to tobacco use, (3) sites not related to screening, and (4) sites not related to tobacco use or screening.

Results

There was higher cancer incidence among those living in areas with higher levels of poverty for sites not strongly related to tobacco use or screening, among Whites, Blacks, and Asians, but not among Latinos. Among Whites there was no relationship with census tract poverty at lower levels of poverty—the relationship with cancer incidence was primarily among those in higher poverty. For Blacks and Asians, there is a more linear relationship with cancer incidence across levels of poverty.

Conclusions

SEP gradients in cancer incidence remain after exclusion of cancer sites strongly related to tobacco use and screening. Our findings demonstrate a need for research on other environmental and social causes of cancer where exposures are differentially distributed by SEP.

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Acknowledgments

We thank the Robert Wood Johnson Foundation Health & Society Scholars program for salary support for DHR at the time this work was initiated, as well as a pilot project grant from the University of California San Francisco/University of California Robert Wood Johnson Foundation Health & Society Scholars site to DHR and RAH for specific funding for this project. DHR is supported by a grant from the National Institute of Aging (Grant No. K01 AG047280). All authors thank Scarlett Lin Gomez for helpful comments on an earlier version of the manuscript. DHR would like to acknowledge funding support from NIH AG047280 and the Robert Wood Johnson Health and Society Scholars Program UC San Francisco/UC Berkeley.

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Authors and Affiliations

  1. Division of Primary Care & Population Health, School of Medicine, Stanford University, 1070 Arastradero Road, Room 280, Palo Alto, Stanford, CA, 94304, USA

    David H. Rehkopf

  2. Cancer Registry of Greater California, Public Health Institute, Sacramento, CA, USA

    Danielle Rodriguez, Rosemary Cress & Dee West

  3. Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA

    Dejana Braithwaite

  4. Stanford Cancer Institute and the Canary Center at Stanford for Cancer Early Detection, School of Medicine, Stanford University, Stanford, CA, USA

    Ingrid Oakley-Girvan & Dee West

  5. Cancer Prevention Institute of California, Fremont, CA, USA

    Ingrid Oakley-Girvan & Dee West

  6. Division of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA

    Robert A. Hiatt

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  1. David H. Rehkopf
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Correspondence to David H. Rehkopf.

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Rehkopf, D.H., Rodriguez, D., Cress, R. et al. Socioeconomic gradients in cancer incidence by race and ethnicity in California, 2008–2012: the influence of tobacco use or screening detectable cancers. Cancer Causes Control 30, 697–706 (2019). https://doi.org/10.1007/s10552-019-01172-4

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  • DOI: https://doi.org/10.1007/s10552-019-01172-4

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