Association between racialized economic segregation and stage at diagnosis for 3 screenable cancers in New York City

Abstract

Background Racial and economic segregation can create barriers to timely cancer diagnosis and adversely affect survival. This study examines the association between neighborhood-level segregation, measured by the neighborhood-Index of Concentration at Extremes (n-ICE), and stage at diagnosis (advanced [regional/distant] vs localized) for 3 screenable cancers in New York City. Methods We analyzed 98 449 incident cases (breast, 58 970; cervical, 4790; and colorectal, 34 689) using New York State Cancer Registry data (2008-2019). Census tract-level n-ICE measures of racial and/or income-based economic segregation were calculated. Age-adjusted stage-specific incidence rates and advanced-to-localized incidence rate ratios (IRRs) were measured across n-ICE quartiles. Results Advanced-to-localized stage IRRs were significantly higher in the most-deprived and/or non-Hispanic Black (NHB)-concentrated areas (Q1) than the most-affluent and/or most non-Hispanic White (NHW)-concentrated areas (Q4) for breast and cervical cancer (breast: n-ICEIncome, IRRQ1 = 0.71 vs IRRQ4 = 0.48; n-ICENHB, IRRQ1 = 0.75 vs IRRQ4 = 0.53; n-ICENHB+Income, IRRQ1 = 0.74 vs IRRQ4 = 0.47; cervical: n-ICEIncome, IRRQ1 = 1.30 vs IRRQ4 = 0.97; n-ICENHB, IRRQ1 = 1.44 vs IRRQ4 = 0.99; n-ICENHB+Income, IRRQ1 = 1.37 vs IRRQ4 = 0.92) (all P-values