Abstract 4833: Impact of poverty in surrounding neighborhoods in cancer mortality in the US: A nationwide study among US women
Authors: Nwigwe Ifeoma , Desjardins Michael , Visvanathan Kala 
Published: March 2024

Abstract
Background: Poverty at the individual and county levels is known to lead to worse cancer outcomes. We believe the relationship between poverty and cancer may involve individual-level factors including tumor biology, socioeconomic status, and community measures that alter cancer outcomes such as death. We aim to understand to what extent poverty in the surrounding neighborhood may identify counties at the highest risk of cancer mortality and whether it is modifiable.
Methods: This study used data collected by SEER to examine the association between neighborhood effects of poverty on the top three sites of cancer mortality among women. We included women &gt;= 20 years of age diagnosed with breast, lung, and colorectal cancer between 2005-2009 and 2010-2014 who survived more than one year after diagnosis. We determined county-level neighborhood poverty environments using local spatial autocorrelation (LISA) analysis with Local Moran’s I of five-year county-level poverty estimates from the American Community Survey. US counties with poverty estimates above or below the national median were defined as high (H)- or low (L)- poverty counties, respectively. We defined neighborhood poverty environments as H-counties among H-counties (HH), L-counties among L-counties (LL), H-counties among LL-counties (HL), and L-counties among HH-counties (LH). We used a Poisson regression model adjusting for age at diagnosis, race/ethnicity, cancer stage, year of diagnosis, treatment, and cancer type to assess county-level neighborhood poverty environment effects on cancer mortality. We also used stratified analyses to explore the effect of cancer type, stage, and race/ethnicity strata on the association between neighborhood poverty environments and cancer death.
Results: Our analysis includes 36,481 women with 4,740 cancer deaths. In total 7,182 women were in HH counties; 21,112 women were in LL counties; 6,476 women were in HL counties; and 1,711 women were in LH counties. Women in HH, LH, and HL counties had a respective 1.23 [95%CI:1.14,1.32], 1.20 [95%CI:1.05,1.36], and 0.95 [95%CI: 0.88,1.03] relative risk (RR) of cancer death when compared to deaths in LL counties. In our stratified analyses, women with breast cancer in HH and HL counties had higher cancer deaths (RR = 1.21 [95%CI:1.03,1.42] and 1.37 [95%CI:1.13,1.65], respectively) when compared to women with lung cancer. We also observed higher cancer deaths from counties that were LL in 2005-2009 and changed to HH counties in 2010-2014 (RR = 1.60 [95%CI:0.85,2.68]) when compared to unchanged LL counties.
Conclusion: We used LISA spatial clustering to demonstrate the effects HH and LH environments have on cancer mortality. We also demonstrate the impact that changes in neighborhood environments can have on cancer mortality. Our findings suggest that prioritization of resource allocations to HH neighborhoods could improve the burden of women with cancer.
Citation Format: Ifeoma Nwigwe, Michael Desjardins, Kala Visvanathan. Impact of poverty in surrounding neighborhoods in cancer mortality in the US: A nationwide study among US women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4833.