Income, Race, and Survival among Low-Income Black and White Americans with Lung, Breast, Prostate, or Colorectal...

Race and income are social factors that contribute to persistent inequities in cancer care delivery/outcomes. However, cancer disparity 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 the 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. More than 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, body mass index, chronic obstructive pulmonary disease, persistent poverty, and enrollment year and source (HR = 0.78; 95% confidence interval, 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% confidence interval, 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.