Cancer differentials among US blacks and whites: quantitative estimates of socioeconomic-related risks

This article analyzes 10 studies that assessed the association of socioeconomic status (SES) with cancer occurrence among blacks and whites in the United States. The following summative inferences were made: the associations of SES with cancer are similar among blacks and whites; cancers of organ sites with the most intimate environmental interfaces have the strongest SES-cancer associations (stomach, lung, cervix, and rectum); the prevalence of exposure to low socioeconomic-related risks such as poverty are approximately fourfold greater among blacks; the all-site population attributable risk percent due to low socioeconomic exposure among blacks is estimated to be four times that of whites, and similar data trends were observed for individual cancer sites such as the stomach and lung; and the three cancer sites of the stomach, lung, and cervix uteri account for nearly half of the observed US black-white cancer rate difference. This review also found all 10 of the primary studies in this field to be ecological with respect to socioeconomic exposure measurement, ie, they used aggregate measures (eg, census tract median education or family income) to characterize the individual's exposure. The need for direct empirical validation of such measures to aid in interpretation of the extant data in this field is underscored.