Racial segregation and disparities in cancer stage for seniors

J Gen Intern Med. 2008 May;23(5):699-705. doi: 10.1007/s11606-008-0545-9. Epub 2008 Mar 13.


Background: Disparities in cancer survival may be related to differences in stage. Segregation may be associated with disparities in stage, particularly for cancers for which screening promotes survival.

Objectives: The objective of the study was to examine whether segregation modifies racial/ethnic disparities in stage.

Design: The design of the study was analysis of Surveillance, Epidemiology, and End Results Medicare data for seniors with breast, colorectal, lung, and prostate cancer (n = 410,870).

Measurements and main results: The outcome was early- versus late-stage diagnosis. Area of residence was categorized into 4 groups: low segregation/high income (potentially the most advantaged), high segregation/high income, low segregation/low income, and high segregation/low income (possibly the most disadvantaged). Blacks were less likely than whites to be diagnosed with early-stage breast, colorectal, or prostate cancer, regardless of area. For colorectal cancer, the black/white disparity was largest in low-segregation/low-income areas (black/white odds ratio [OR] of early stage 0.51) and smallest in the most segregated areas (ORs 0.71 and 0.74, P < .005). Differences in disparities in stage by area category were not apparent for breast, prostate, or lung cancer. Whereas there were few Hispanic-white differences in early-stage diagnosis, the Hispanic/white disparity in early-stage diagnosis of breast cancer was largest in low-segregation/low-income areas (Hispanic/white OR of early stage 0.54) and smallest in high-segregation/low-income areas (OR 0.96, P < .05 compared to low-segregation/low-income areas).

Conclusions: Disparities in stages for cancers with an established screening test were smaller in more segregated areas.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • African Americans*
  • Aged
  • Aged, 80 and over
  • Female
  • Healthcare Disparities*
  • Humans
  • Male
  • Mass Screening*
  • Neoplasm Staging*
  • Neoplasms / diagnosis
  • Neoplasms / ethnology*
  • Neoplasms / pathology
  • Odds Ratio
  • Prejudice*
  • Residence Characteristics
  • SEER Program*
  • United States
  • Whites