Association Between Social Vulnerability and Gastrointestinal Cancer Mortality in the United States Counties

Chun-Han Lo; Kyaw Min Tun; Chun-Wei Pan; Jeffrey K Lee; Harminder Singh; N Jewel Samadder

doi:10.1016/j.gastha.2024.05.007

Association Between Social Vulnerability and Gastrointestinal Cancer Mortality in the United States Counties

Gastro Hep Adv. 2024 Jun 7;3(6):821-829. doi: 10.1016/j.gastha.2024.05.007. eCollection 2024.

Authors

Chun-Han Lo¹, Kyaw Min Tun¹, Chun-Wei Pan², Jeffrey K Lee^{3

4}, Harminder Singh^{5

6}, N Jewel Samadder^{7

8

9}

Affiliations

¹ Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada.
² Cook County Health, John H. Stroger Hospital, Chicago, Illinois.
³ Division of Research, Kaiser Permanente Northern California, Oakland, California.
⁴ Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California.
⁵ CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada.
⁶ Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
⁷ Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Phoenix, Arizona.
⁸ Department of Clinical Genomics, Mayo Clinic, Phoenix, Arizona.
⁹ Center for Individualized Medicine, Mayo Clinic, Phoenix, Arizona.

Abstract

Background and aims: Social determinants of health contribute to disparities in gastrointestinal (GI) cancer mortality between individuals in the US. Their effects on count-level mortality rates remain uncertain. We aimed to assess the association between county social vulnerability and GI cancer mortality.

Methods: In this ecological study (2016-2020), we obtained US county Social Vulnerability Index (SVI) from the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry and age-adjusted mortality rates (AAMRs) for GI cancers from Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiological Research). SVI ranges from 0 to 1, with higher indices indicating greater vulnerability. We presented AAMRs by quintiles of SVIs. We used Poisson regression through generalized estimating equation to calculate rate ratios (RRs) and 95% confidence intervals (CIs) for GI cancer mortality by quintiles of SVI.

Results: There were 799,968 deaths related to GI cancers from 2016 to 2020, resulting in an AAMR (95% CI) of 39.9 (41.4-51.2) deaths per 100,000 population. The largest concentration of counties with greater SVI and GI cancer mortality was clustered in the southern US. Counties with greater SVI had higher mortality related to all GI cancers (RR_{Q5 vs Q1}, 1.19 [95% CI, 1.14-1.24]), gastric cancer (1.58 [1.48-1.69]), liver cancer (1.54 [1.36-1.73]), and colorectal cancer (RR_{Q5 vs Q1}, 1.23 [95% CI, 1.15-1.31]). RRs for overall GI cancers were greater among individuals <45 years (1.24 [1.15-1.32]), men (1.22 [1.16-1.27]), Hispanic individuals (1.33 [1.18-1.50]), and rural counties (1.21 [1.14-1.27]) compared with their counterparts.

Conclusion: Socially disadvantaged counties face a disproportionately high burden of GI cancer mortality in the US. Targeted public health interventions should aim to address social inequities faced by underserved communities.

Keywords: Disparity; Epidemiology; Public Health; Social Inequities; Socioeconomic Status.