In a study reported in a research letter in JAMA Oncology, Cham et al found that cervical cancer incidence increased with decreasing socioeconomic status index scores across neighborhoods in New York City (NYC).
Study Details
The population-based, cross-sectional study included data on women living in NYC from 2012 through 2016. Cases of cervical cancer and age-standardized incidence rates by neighborhood were derived from the New York State Cancer Registry and linked with self-reported neighborhood-level data from the U.S. Census Bureau’s American Community Survey. A socioeconomic status index score was assigned to neighborhoods using Agency for Healthcare Research and Quality methods (weighted combination of crowding, real-estate values, poverty rates, incomes, educational attainment, and unemployment). Neighborhoods were categorized by socioeconomic status index decile, with those in the 10th percentile having the lowest socioeconomic status.
Key Findings
A total of 932 cases of cervical cancer were diagnosed in 55 NYC neighborhoods during the study period, yielding an age-standardized incidence rate of 9.1 cases per 100,000 woman-years (95% confidence interval [CI] = 8.7–9.5/100,000 woman-years).
In this …study, we found that New York’s lowest socioeconomic status neighborhoods, populated predominantly by Black and Hispanic residents, had cervical cancer incidence rates 73% higher than the mostly White populations of the city’s highest socioeconomic status neighborhoods.— Cham et al
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Age-standardized incidence rates varied markedly across neighborhoods, ranging from 4.4 (95% CI = 2.9–7.4) to 14.7 (95% CI = 10.8–19.5) cases/100,000 woman-years.
Marked variations in socioeconomic and demographic factors were identified across neighborhoods. Among residents of neighborhoods in the highest socioeconomic status index decile, 68.9% were White, 11.6% were Hispanic, and 4.5% were Black. Among residents in the lowest-decile neighborhoods, 60.1% were Hispanic, 33.5% were Black, and 3.0% were White.
Neighborhood socioeconomic status index was strongly associated with cervical cancer incidence, with incidence rates increasing with decreasing index values. After standardization for age, risk for cervical cancer among women in the lowest socioeconomic status index neighborhoods was increased by 73% vs those in the highest-index neighborhoods: the interdecile incidence rate ratio was 1.73 (95% CI = 1.52–1.96, P < .001), corresponding to age-adjusted incidence rates of 11.2 (95% CI = 10.3–12.2) vs 6.5 (95% CI = 5.9–7.1) cases/ 100,000 woman-years.
The investigators stated, “In this …study, we found that New York’s lowest socioeconomic status neighborhoods, populated predominantly by Black and Hispanic residents, had cervical cancer incidence rates 73% higher than the mostly White populations of the city’s highest socioeconomic status neighborhoods. The magnitude of this disparity exceeds those associated with Black race, Hispanic ethnicity, or residence in a rural county in a population-based study of the United States …The existence of this disparity among persons living in proximity highlights the need to implement targeted neighborhood-level interventions to increase access to, and utilization of, preventive services, including vaccination and screening. Interventions that leverage social determinants of health, including neighborhood and built environment, social/community support systems, education, economic stability, and health-care access, to increase cancer screening in vulnerable populations, have been shown to be cost-effective.”
Alexander Melamed, MD, MPH, of NewYork-Presbyterian Hospital, Herbert Irving Comprehensive Cancer Center, Columbia University Vagelos College of Physicians and Surgeons, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by the Conquer Cancer Foundation and National Center for Advancing Translational Sciences. For full disclosures of the study authors, visit jamanetwork.com.
