Gender disparities in lung cancer and social determinants of environmental risk: a geospatial analysis across Illinois counties.

BACKGROUND

Lung cancer remains the leading cause of cancer-related death in Illinois. While tobacco use is the primary risk factor, environmental exposures and social determinants of health (SDOH)-such as housing conditions and socioeconomic vulnerability-also shape cancer risk across geographic and demographic groups.

OBJECTIVES

This study examines the impact of radon exposure, smoking prevalence, and housing-related vulnerability on lung cancer incidence among males and females across all 102 counties in Illinois.

METHODS

We conducted comprehensive county-level analyses of social determinants of health indicators to examine their influence on lung cancer using sex-stratified, age-adjusted lung cancer incidence rates (2017-2021 average). Additionally, further examinations using spatial analyses with bi-variate choropleth mapping approaches were performed to target underserved populations. Independent variables included radon exposures, such as average residential radon levels, adult smoking prevalence, and housing-related indicators from the CDC/ATSDR Social Vulnerability Index (SVI). Multivariate linear regression models were developed separately for males and females. Geospatial bivariate choropleth maps were created to highlight overlapping hotspots of cancer burden and environmental exposures.

RESULTS

Smoking prevalence was the strongest predictor of lung cancer for both sexes. Radon exposure significantly predicted female lung cancer incidence ( β = 0.195, p = 0.027), whereas housing-related vulnerability was significant only for males ( β = 0.234, p = 0.009). Geospatial analyses identified priority regions for targeted interventions, including high-risk radon zones in northwestern Illinois for females and housing-vulnerable counties in central and eastern Illinois for males.

CONCLUSION

This study highlights the role of sex-specific interactions between environmental risk and social vulnerability in contributing to lung cancer disparities. Integrating geospatial and ecological analyses through the SDOH lens can inform tailored public health interventions that advance health equity and environmental justice in cancer prevention.