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      Health Disparities and Cancer: Racial Disparities in Cancer Mortality in the United States, 2000–2010

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          Abstract

          Declining cancer incidence and mortality rates in the United States (U.S.) have continued through the first decade of the twenty-first century. Reductions in tobacco use, greater uptake of prevention measures, adoption of early detection methods, and improved treatments have resulted in improved outcomes for both men and women. However, Black Americans continue to have the higher cancer mortality rates and shorter survival times. This review discusses and compares the cancer mortality rates and mortality trends for Blacks and Whites. The complex relationship between socioeconomic status and race and its contribution to racial cancer disparities is discussed. Based on current trends and the potential and limitations of the patient protection and affordable care act with its mandate to reduce health care inequities, future trends, and challenges in cancer mortality disparities in the U.S. are explored.

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          Most cited references80

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          Theories for social epidemiology in the 21st century: an ecosocial perspective.

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            The influence of finasteride on the development of prostate cancer.

            Androgens are involved in the development of prostate cancer. Finasteride, an inhibitor of 5alpha-reductase, inhibits the conversion of testosterone to dihydrotestosterone, the primary androgen in the prostate, and may reduce the risk of prostate cancer. In the Prostate Cancer Prevention Trial, we randomly assigned 18,882 men 55 years of age or older with a normal digital rectal examination and a prostate-specific antigen (PSA) level of 3.0 ng per milliliter or lower to treatment with finasteride (5 mg per day) or placebo for seven years. Prostate biopsy was recommended if the annual PSA level, adjusted for the effect of finasteride, exceeded 4.0 ng per milliliter or if the digital rectal examination was abnormal. It was anticipated that 60 percent of participants would have prostate cancer diagnosed during the study or would undergo biopsy at the end of the study. The primary end point was the prevalence of prostate cancer during the seven years of the study. Prostate cancer was detected in 803 of the 4368 men in the finasteride group who had data for the final analysis (18.4 percent) and 1147 of the 4692 men in the placebo group who had such data (24.4 percent), for a 24.8 percent reduction in prevalence over the seven-year period (95 percent confidence interval, 18.6 to 30.6 percent; P<0.001). Tumors of Gleason grade 7, 8, 9, or 10 were more common in the finasteride group (280 of 757 tumors [37.0 percent], or 6.4 percent of the 4368 men included in the final analysis) than in the placebo group (237 of 1068 tumors [22.2 percent], P<0.001 for the comparison between groups; or 5.1 percent of the 4692 men included in the final analysis, P=0.005 for the comparison between groups). Sexual side effects were more common in finasteride-treated men, whereas urinary symptoms were more common in men receiving placebo. Finasteride prevents or delays the appearance of prostate cancer, but this possible benefit and a reduced risk of urinary problems must be weighed against sexual side effects and the increased risk of high-grade prostate cancer. Copyright 2003 Massachusetts Medical Society
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              Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter?: the Public Health Disparities Geocoding Project.

              N Krieger (2002)
              Despite the promise of geocoding and use of area-based socioeconomic measures to overcome the paucity of socioeconomic data in US public health surveillance systems, no consensus exists as to which measures should be used or at which level of geography. The authors generated diverse single-variable and composite area-based socioeconomic measures at the census tract, block group, and zip code level for Massachusetts (1990 population: 6,016,425) and Rhode Island (1990 population: 1,003,464) to investigate their associations with mortality rates (1989-1991: 156,366 resident deaths in Massachusetts and 27,291 in Rhode Island) and incidence of primary invasive cancer (1988-1992: 140,610 resident cases in Massachusetts; 1989-1992: 19,808 resident cases in Rhode Island). Analyses of all-cause and cause-specific mortality rates and all-cause and site-specific cancer incidence rates indicated that: 1) block group and tract socioeconomic measures performed comparably within and across both states, but zip code measures for several outcomes detected no gradients or gradients contrary to those observed with tract and block group measures; 2) similar gradients were detected with categories generated by quintiles and by a priori categorical cutpoints; and 3) measures including data on economic poverty were most robust and detected gradients that were unobserved using measures of only education and wealth.
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                Author and article information

                Contributors
                URI : http://frontiersin.org/people/u/100245
                URI : http://frontiersin.org/people/u/206341
                URI : http://frontiersin.org/people/u/149161
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                15 April 2015
                2015
                : 3
                : 51
                Affiliations
                [1] 1Department of Health Sciences, Boston University , Boston, MA, USA
                [2] 2Slone Epidemiology Center, Boston University , Boston, MA, USA
                Author notes

                Edited by: Jimmy Thomas Efird, Brody School of Medicine, USA

                Reviewed by: Hope Landrine, East Carolina University, USA; Faith G. Davis, University of Alberta, Canada

                *Correspondence: Eileen B. O’Keefe, Department of Health Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA e-mail: ebokeefe@ 123456bu.edu

                This article was submitted to Epidemiology, a section of the journal Frontiers in Public Health.

                Article
                10.3389/fpubh.2015.00051
                4398881
                25932459
                2b3a1971-d556-4df8-bc7a-1c44dd7f16da
                Copyright © 2015 O’Keefe, Meltzer and Bethea.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 07 January 2015
                : 11 March 2015
                Page count
                Figures: 5, Tables: 3, Equations: 0, References: 114, Pages: 15, Words: 11509
                Funding
                Funded by: Boston University
                Funded by: National Cancer Institute of the National Institutes of Health
                Award ID: R01CA058420
                Categories
                Public Health
                Review Article

                cancer mortality,socioeconomic status,race/ethnicity,disparities,affordable care act

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