Race and neighborhood social determinants of premature cancer mortality in California adults, 2015-2021.

PURPOSE: To investigate social determinants of cancer mortality and effect modification by race/ethnicity, age, sex, and Covid-19 pandemic period in Californian adults.

METHODS

The Healthy Places Index (HPI) measures neighborhood socioeconomic and environmental conditions, and access to healthcare. We aggregated 224,997 cancer deaths to 2010 census tracts from death certificates and populations from U.S. census, 2015-2021. In this cross-sectional study, we age-adjusted death rates of HPI deciles and examined HPI dose-response with segmental regression.

RESULTS

From 2015 to 2019, all-cancer mortality rates declined 5.1 % per HPI decile. The rate ratio between the 1st and 10th decile was 1.67 (CI95 %: 1.58-1.77) for all cancers, 2.07 (1.81-2.37) for lung, 1.79 (1.49-2.16) for colorectal, 1.75 (1.28-2.37) for prostate, and 1.22 (1.01-1.48) for breast cancer. The HPI-all-cancer gradient in 2020-2021 was little changed from 2015 to 2019, but rates averaged 8 % lower. Disparities in death rates between race/ethnicity groups were comparable to those between HPI deciles within race/ethnicity groups. The site-specific HPI-attributable percent of mortality was: all cancers (27 %), lung (39 %), prostate (31 %), colorectal (29 %), and breast ((16 %).

CONCLUSIONS

Disparities in cancer mortality associated with social determinants of health were similar and large before and during the Covid-19 pandemic.