A small number of key factors are responsible for 80% of the disparities in cancer mortality between regions. Actions specific to each region can be adapted to local specificities.
While cancer death rates have declined overall in the United States over the past decades, significant disparities remain between regions and are widening. A phenomenon that is not unique to America.
Using a new statistical method, the Yale University research team identified factors associated with disparities between counties (such as departments). These factors include both socio-economic and behavioral characteristics (obesity, smoking, etc.), which can make it possible to determine priority targets in each region to reduce disparities in terms of cancer. The study was published in JAMA Network Open.
Significant disparities
The research team confirmed the existence of significant disparities between counties in the United States in the frequency of cancer deaths, ranging from 186 deaths per 100,000 population in high-income counties to 230 deaths per 100,000 population in low income counties.
To examine the factors that could explain these disparities, a team of researchers led by Yale analyzed data on population and cancer death rates by county. They compared the rates for low, middle and high income counties.
A small number of key factors
The analysis revealed that 80% of these disparities could be explained by a small number of key factors, both socio-economic and lifestyle. The most important of these factors seem to be: food insecurity, which explains 19.1% of these disparities), the quality of health care provided (17.9%), smoking (12.7%) and physical inactivity (12.2%).
In addition, these factors differ by region, and disparities in cancer mortality can be attributed to a combination of factors specific to each region and which involve both income and behavior.
Targeted corrective actions
“The work suggests that all of the factors identified interact to lead to these disparities,” said first author Jeremy O’Connor, who conducted the research while a National Clinician Scholar at the Yale School of Medicine.
“These are not just behaviors related to health or the quality of care; these are all factors combined.”
But, this is the first time that in a developed country, we observe that the poor quality of care can be a more important factor of inequality than tobacco or sedentary lifestyle. We have concerns in France if medical desertification continues.
This approach is to be replicated in France so as to allow public health officials in the different regions of the country to identify the specific factors affecting the French departments and to react accordingly. Indeed, according to O’Connor: “Instead of each county considering the eight factors, it can target its public health programs on the factors most important to its community.”
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