Residential Segregation and Lung Cancer Mortality in the United States | Health Disparities | JAMA Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Underwood JM, Townsend JS, Tai E,  et al.  Racial and regional disparities in lung cancer incidence.  Cancer. 2011;118(7):1910-191821918961PubMedGoogle ScholarCrossref
Gadgeel SM, Kalemkerian GP. Racial differences in lung cancer.  Cancer Metastasis Rev. 2003;22(1):39-4612716035PubMedGoogle ScholarCrossref
Hayanga AJ, Waljee AK, Kaiser HE, Chang DC, Morris AM. Racial clustering and access to colorectal surgeons, gastroenterologists, and radiation oncologists by African Americans and Asian Americans in the United States: a county-level data analysis.  Arch Surg. 2009;144(6):532-53519528386PubMedGoogle ScholarCrossref
Gadgeel SM, Ivy P, Chen W, Mauer J, Smith D, Lorusso P. Analysis of lung cancer patients enrolled in CTEP (Cancer Therapy Evaluation Program)–sponsored phase I trials.  Clin Lung Cancer. 2011;12(4):218-22321726820PubMedGoogle ScholarCrossref
 Surveillance Research Program, National Cancer Institute. SEER*Stat software. Accessed October 28, 2012
 Surveillance, Epidemiology and End Results (SEER) Program. November 2009; Mortality—all COD, aggregated with county, total US (1969-2007), Katrina/Rita population adjustment, released April 2010, based on the November 2009 submission. Accessed October 28, 2012
White MJ. Segregation and diversity measures in population distribution.  Popul Index. 1986;52(2):198-22112340704PubMedGoogle ScholarCrossref
Hayanga AJ, Kaiser HE, Sinha R, Berenholtz SM, Makary M, Chang D. Residential segregation and access to surgical care by minority populations in US counties.  J Am Coll Surg. 2009;208(6):1017-102219476885PubMedGoogle ScholarCrossref
Nelder PMJA. Generalized Linear Models. 2nd ed. London, England: CRC Press; 1989:532
Long JS, Freese J. Regression Models for Categorical Dependent Variables Using Stata. 2nd ed. College Station, TX: Stata Press; 2006:527
US Department of Agriculture, National Agricultural Statistics Service, Research and Development Division, Geospatial Information Branch.  Spatial Analysis Research. 2011. Accessed October 28, 2012
 Population Studies Center, University of Michigan. Racial Residential Segregation Measurement Project. Accessed October 28, 2012
Morello-Frosch R, Jesdale BM. Separate and unequal: residential segregation and estimated cancer risks associated with ambient air toxics in U.S. metropolitan areas.  Environ Health Perspect. 2006;114(3):386-39316507462PubMedGoogle ScholarCrossref
Ludwig J, Sanbonmatsu L, Gennetian L,  et al.  Neighborhoods, obesity, and diabetes: a randomized social experiment.  N Engl J Med. 2011;365(16):1509-151922010917PubMedGoogle ScholarCrossref
US Housing Scholars and Research and Advocacy Organizations.  Residential Segregation and Housing Discrimination in the United States: Violations of the International Convention on the Elimination of All Forms of Racial Discrimination: A Report to the U.N. Committee on the Elimination of Racial Discrimination. Washington, DC: US Housing Scholars and Research and Advocacy Organizations; 2008
Collins CA. Racism and health: segregation and causes of death amenable to medical intervention in major U.S. cities.  Ann N Y Acad Sci. 1999;896:396-39810681933PubMedGoogle ScholarCrossref
Anderson RT, Sorlie P, Backlund E, Johnson N, Kaplan GA. Mortality effects of community socioeconomic status.  Epidemiology. 1997;8(1):42-479116094PubMedGoogle ScholarCrossref
Schulz AJ, Williams DR, Israel BA, Lempert LB. Racial and spatial relations as fundamental determinants of health in Detroit.  Milbank Q. 2002;80(4):677-707, iv12532644PubMedGoogle ScholarCrossref
Pérez-Stable EJ, Benowitz NL, Marín G. Is serum cotinine a better measure of cigarette smoking than self-report?  Prev Med. 1995;24(2):171-1797597020PubMedGoogle ScholarCrossref
Trinidad DR, Pérez-Stable EJ, Messer K, White MM, Pierce JP. Menthol cigarettes and smoking cessation among racial/ethnic groups in the United States.  Addiction. 2010;105:(suppl 1)  84-9421059139PubMedGoogle ScholarCrossref
Massey DS. Segregation and stratification: a biosocial perspective.  Du Bois Rev. 2004;1(1):7-25Google ScholarCrossref
Department of Health and Human Services.  Healthy People 2010. Accessed October 28, 2012
Aberle DR, Adams AM, Berg CD,  et al; National Lung Screening Trial Research Team.  Reduced lung-cancer mortality with low-dose computed tomographic screening.  N Engl J Med. 2011;365(5):395-40921714641PubMedGoogle ScholarCrossref
Original Article
January 2013

Residential Segregation and Lung Cancer Mortality in the United States

Author Affiliations

Author Affiliations: Division of Cardiothoracic Surgery (Drs Hayanga and Backhus) and Department of Health Services (Dr Zeliadt), University of Washington, and Department of Veterans Affairs Medical Center, Health Services Research & Development Service (Dr Zeliadt), and Department of Surgery, Veterans Affairs Medical Center (Dr Backhus), Seattle, Washington.

JAMA Surg. 2013;148(1):37-42. doi:10.1001/jamasurgery.2013.408

Objective To examine the relationship between race and lung cancer mortality and the effect of residential segregation in the United States.

Design A retrospective, population-based study using data obtained from the 2009 Area Resource File and Surveillance, Epidemiology and End Results program.

Setting Each county in the United States.

Patients Black and white populations per US county.

Main Outcome Measures A generalized linear model with a Poisson distribution and log link was used to examine the association between residential segregation and lung cancer mortality from 2003 to 2007 for black and white populations. Our primary independent variable was the racial index of dissimilarity. The index is a demographic measure that assesses the evenness with which whites and blacks are distributed across census tracts within each county. The score ranges from 0 to 100 in increasing degrees of residential segregation.

Results The overall lung cancer mortality rate was higher for blacks than whites (58.9% vs 52.4% per 100 000 population). Each additional level of segregation was associated with a 0.5% increase in lung cancer mortality for blacks (P < .001) and an associated decrease in mortality for whites (P = .002). Adjusted lung cancer mortality rates among blacks were 52.4% and 62.9% per 100 000 population in counties with the least (<40% segregation) and the highest levels of segregation (≥60% segregation), respectively. In contrast, the adjusted lung cancer mortality rates for whites decreased with increasing levels of segregation.

Conclusion Lung cancer mortality is higher in blacks and highest in blacks living in the most segregated counties, regardless of socioeconomic status.