Publication date: Jul 11, 2025
To investigate social determinants of cancer mortality and effect modification by race/ethnicity, age, sex, and Covid-19 pandemic period in Californian adults. 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 to 2021. In this cross-sectional study, we age-adjusted death rates of HPI deciles and examined HPI dose-response with segmental regression. From 2015 to 2019, all-cancer mortality rates declined 5. 1% per HPI decile. The rate ratio between the 1 and 10 decile was 1. 67 (CI: 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 2015-2019, 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%), 31% (prostate), 29% (colorectal), and 16% (breast). Disparities in cancer mortality associated with social determinants of health were similar and large before and during the Covid-19 pandemic.
| Concepts | Keywords |
|---|---|
| Californian | Covid-19 |
| Cancer | health equity |
| Race | mortality |
| Socioeconomic | neoplasms |
| racial groups | |
| social class |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | cancer |
| disease | MESH | Covid-19 pandemic |
| disease | MESH | death |
| disease | MESH | breast cancer |
| pathway | KEGG | Breast cancer |
| drug | DRUGBANK | Flunarizine |
| disease | IDO | site |