Abstract C065: Stage-specific cancer survival in Black and White individuals by urbanicity of county of residence
Authors: Islami Farhad , Wiese Daniel , Schafer Elizabeth , Sung Hyuna , Jemal Ahmedin 
Published: September 2024

Abstract
Cancer survival rates are generally lower in Black than White individuals. We examined stage-specific cancer survival in non-Hispanic Black (Black) and non-Hispanic White (White) individuals by urbanicity of county of residence. Data on 5-year stage-specific cancer survival for all, lung, female breast, prostate, and colorectal cancers diagnosed in 2014-2020 were obtained from the Surveillance, Epidemiology, and End Results Program 22 registries. Urbanicity, based on the 2013 Rural-Urban Continuum Codes, was consolidated into four categories: county of residence in a large metropolitan (population ≥1 million), medium metropolitan (250,000-&lt;1 million), small metropolitan (&lt;250,000), and non-metropolitan area. The overall 5-year cancer survival for each stage was lower in Black than White individuals and in non-metropolitan than metropolitan areas. After stratification by both race and urbanicity, the 5-year survival for localized-stage cancers in Black and White individuals was comparable across categories of urbanicity, except in large metropolitan areas, where it was slightly lower in Black (90.2%, 95%CI=90.0%-90.4%) than White (91.0%, 90.9%-91.1%) individuals. The Black-White difference was larger for regional-stage cancers, for which the 5-year survival was about 5% lower in Black individuals than White individuals across all four categories of urbanicity, e.g., 65.8% (65.3%-66.3%) vs. 70.8% (70.6%-71.1%) in large metropolitan areas. For distant-stage cancers, the Black-White difference in 5-year survival was also about 5% (33.9%, 33.5%-34.4% vs. 38.6%, 38.4%-38.9%) in large metropolitan areas, but the difference in other areas was smaller. After stratification by age group, the Black-White differences were larger in ages &lt;65 years. For example, the Black-White difference in 5-year survival for localized-, regional-, and distant-stage cancer in ages &lt;65 years in large metropolitan areas was 2.1%, 8.6%, and 8.4%, respectively. The Black-White differences in survival also varied by cancer type. The stage-specific survival was lower in Black than White individuals across most categories of urbanicity, especially in large metropolitan areas in ages &lt;65 years, for breast and colorectal cancer, localized-stage lung cancer, and localized- and regional-stage prostate cancer (&lt;65 years only), with little differences in other evaluated stages. Notably, the 5-year survival for distant-stage breast cancer in ages &lt;65 years in large metropolitan areas was about 16% lower in Black females (26.7%, 95%CI=24.3%-29.2%) than White females (43.1%, 41.3%-44.9%); the corresponding difference in ages ≥65 years was about 4% (23.1%, 19.9%-26.5% vs. 26.7, 25.0%-28.4%, respectively). Black-White differences in stage-specific cancer survival vary by cancer type, urbanicity, and age, and generally are larger in metropolitan areas and younger ages. These differences may largely reflect disparities in receipt of quality care, especially in large metropolitan areas and younger ages, due to inequities in social determinants of health, including health insurance coverage.
Citation Format: Farhad Islami, Daniel Wiese, Elizabeth Schafer, Hyuna Sung, Ahmedin Jemal. Stage-specific cancer survival in Black and White individuals by urbanicity of county of residence [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C065.