The Effect of Persistent Poverty on Cancer Outcomes in California

Area of Science:

• Oncology
• Public Health
• Health Disparities

Background:

• Persistent poverty areas (PPAs) are linked to advanced cancer stages and reduced survival nationally.
• Previous research has not specifically examined the impact of PPAs on cancer diagnosis stage and survival within California.
• Understanding these disparities in California is vital for developing effective cancer control strategies.

Purpose of the Study:

• To investigate the independent effects of living in persistent poverty areas (PPAs) on cancer stage at diagnosis.
• To evaluate the association between PPAs and overall survival for patients diagnosed with specific cancer types in California.
• To inform targeted interventions aimed at mitigating cancer outcome disparities.

Main Methods:

• Utilized data from the California Cancer Registry (2006-2020) for patients aged 15+ diagnosed with nine common cancers.
• Employed multivariable logistic regression to assess the link between PPAs and late-stage cancer diagnosis.
• Applied multivariable Cox proportional hazards regression to determine the effect of PPAs on overall survival.

Main Results:

• A significant proportion of patients (6.0%) resided in PPAs, with demographic differences noted (younger, minority, uninsured, rural).
• Living in PPAs was associated with increased odds of late-stage diagnosis for most cancer types (ORs 1.09-1.46, p<0.02), excluding stomach cancer.
• Patients in PPAs exhibited worse overall survival across all cancer types, even after adjusting for stage and other factors (HRs 1.05-1.35, p>0.01).

Conclusions:

• Findings underscore the negative impact of persistent poverty areas on cancer diagnosis and survival outcomes in California.
• There is a clear need for targeted public health interventions, including enhanced cancer screening education and improved healthcare access in PPAs.
• Addressing socioeconomic factors is essential for reducing cancer health disparities.