Abstract A115: Structural racism and cancer mortality: An examination of US counties
Authors: Robinson-Oghogho Joelle N. , Alcaraz Kassandra I. , Thorpe Roland J. 
Published: December 2023

Abstract
Background: Although some racial disparities in US cancer mortality rates have narrowed over time, many persist; driven by racialized systems of oppression. Few studies have used multidimensional indices to explore the influence of structural racism on cancer outcomes while also accounting for ambient exposures to environmental hazards or opportunities. To add to research on the impact of structural racism on health, we examined associations between county level measures of structural racism and cancer mortality rates, while accounting for factors associated with cancer mortality, and county level measures of environmental burden. Methods: Data for our analysis come from a previously developed index of county level structural racism, and publicly available data on 2015-2019 cancer mortality rates from the United States Cancer Statistics Data Visualization Tool, 2019 County Health Rankings and Roadmaps, EPA’s 2006-2010 Environmental Quality Index, and 2015-2019 estimates from the US Census American Community Survey. Our outcome of interest was the number of deaths for all cancer types per 100,000 people. Our primary independent variable was the county standardized factor score for structural racism. To account for counties’ level of environmental burden we utilized the overall environmental quality index score. We also accounted for factors associated with cancer mortality rates including race (i.e., Non-Hispanic Black, White, Asian/Pacific Islander, American Indian Alaskan Native), adult smoking, obesity, excessive drinking, uninsured, sexually transmitted infection, and mammography screening rates, and the primary care physician to population ratio. Multiple linear regression analyses were used to examine associations between cancer mortality rates and structural racism standardized factor scores, overall and between race groups, while accounting for the aforementioned covariates and county geographic mobility and percent of the population considered rural. Results: Our analyses of 1,026 US counties indicated cancer mortality rates increased by 3.3 deaths per 100,000 people (95% CI: 1.2, 5.3) for every standard deviation increase in structural racism factor score, while controlling for all other covariates. Additionally, we found that race modified the relationship between structural racism and cancer mortality. Compared to the White population, Black cancer mortality rates increased by 11.9 deaths per 100,000 people (95% CI: 8.8, 14.8), Asian/Pacific Islander rates increased by 4.7 deaths per 100,00 people (95% CI: 1.3, 8.1), and American Indian/Alaskan Native mortality rates increased by 17.4 deaths per 100,000 people (95% CI: 4.2, 30.6) for every standard deviation increase in county structural racism factor score. Conclusion: This study demonstrates how race groups are differentially impacted by the social and physical characteristics of their environments. Our analysis extends the evidence illuminating structural racism as a root cause of cancer health disparities.
Citation Format: Joelle N. Robinson-Oghogho, Kassandra I. Alcaraz, Roland J. Thorpe Jr.. Structural racism and cancer mortality: An examination of US counties [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A115.