Association of State and Local Social and Public Health Spending With Cancer Incidence and Mortality

IntroductionThis study aimed to characterize the association between state and local social spending and incidence and mortality of poverty-associated cancers.MethodsThis cross-sectional cohort study (years 2004-2020) included U.S. adults ages 20-64 years with poverty-associated cancers. The exposure was differential and combined state- and local-level spending on social needs for 50 states. Data from the U.S. Census Bureau Census of Governments was used to determine annual social spending for each state. Deciles of spending were calculated annually. Main outcomes were yearly incidence and mortality of poverty-associated cancers, expressed as rate ratios where the first decile serves as the reference for each of deciles 2-10. Poisson regression models evaluated association of social spending with incidence and mortality of poverty-associated cancers, controlling for secular trends and state fixed effects.ResultsOverall median social spending was $7071dollars per capita (IQR $6373-$8098). By combined state/local social spending, yearly cancer incidence rates were lower in the highest deciles of social spending (rate ratio 0.96 (95% CI 0.92-0.99) and 0.92 (95% CI 0.88-0.96) for 9^th and 10^th deciles, respectively). Similarly, yearly cancer mortality rates were lower in the highest deciles of social spending (rate ratio 0.94 (95% CI 0.89-0.98) and 0.91 (95% CI 0.85-0.97) for 9^th and 10^th deciles, respectively).ConclusionThis work demonstrates an association between state and local social spending and decreased incidence and mortality of poverty-associated cancers. These results can inform policies promoting spending on interventions that not only address general welfare but have downstream impacts on cancer risk and outcomes.