Counties and small areas experiencing long-term economic deprivation have been associated with higher cancer-related mortality. This study evaluated whether residence in a census tract designated as persistent poverty at diagnosis is associated with individual overall survival among adults diagnosed with the most common cancers in Alabama. The analysis also addressed how race and rurality intersect with persistent poverty to influence survival.
This is a retrospective cohort study using the Alabama Statewide Cancer Registry. The analytic sample included adults diagnosed with breast, prostate, colorectal, or lung cancer. The primary exposure was tract-level persistent poverty as designated by the NCI based on the 2010 census: census tracts with at least 20% of the population below the federal poverty line for 30 or more years.
The outcome was overall survival measured from the date of diagnosis to death or the end of follow-up. Associations between persistent-poverty tract residence and survival were estimated using sequential Cox proportional hazards models. Modeling proceeded in stages: first with persistent poverty as the sole predictor; then adjusting for demographic variables (age, race, and sex where applicable); followed by addition of clinical characteristics (cancer stage, subtype for breast cancer, and first-course treatment); and finally including social determinants such as rurality and insurance status.
A decomposition analysis was also performed to assess the contribution of race and rurality to the association between persistent poverty and survival. The abstract reports that decomposition was conducted but does not provide detailed component results or numerical breakdowns in the summary.
In models adjusted for demographics, clinical characteristics, and social determinants, living in a persistent-poverty census tract at the time of diagnosis was associated with a higher hazard of death for several cancer types. Specifically, the fully adjusted hazard ratios (HR) reported in the abstract are:
These estimates indicate that, after accounting for measured demographic, clinical, and selected social factors, patients living in persistent-poverty tracts had an elevated risk of death compared with those living in non–persistent-poverty tracts for breast, prostate, and lung cancers. The abstract does not report a fully adjusted hazard ratio for colorectal cancer, nor does it present absolute survival probabilities or median survival times within the abstract.
Race and rurality were each independently associated with higher risk of death across the cancer types studied. The highest magnitude of risk was observed among individuals identifying as Black who resided in rural persistent-poverty tracts; this subgroup had the greatest risk for mortality across all cancers examined. The abstract emphasizes intersectionality — that social identities and place combine to shape cancer outcomes — but it does not provide stratified hazard ratios or specific numerical interaction estimates in the abstract text.
The authors performed a decomposition analysis to explore how much of the association between persistent-poverty tract residence and survival operates through race and rurality. The abstract confirms that this analytic step was completed but does not report the detailed decomposition results, component contributions, or percentage mediation in the summary available.
Residence in a census tract designated as persistent poverty is associated with increased risk of death among patients with breast, prostate, and lung cancer in Alabama, even after adjusting for demographic, clinical, and some social determinants. The findings highlight that race and rurality further compound these survival disparities, with Black residents of rural persistent-poverty tracts experiencing the highest observed mortality risk.
The authors recommend implementing multilevel interventions tailored to local contexts to address the complex interplay of social characteristics and improve cancer outcomes. Specific intervention strategies, evaluation plans, or policy recommendations are not detailed in the abstract.
Keywords listed by the authors include cancer, intersectionality, persistent poverty, social determinants of health, and survival. The abstract provides key adjusted hazard ratios for breast, prostate, and lung cancer but omits some granular results (for example, detailed decomposition outputs, absolute survival estimates, and colorectal cancer fully adjusted HRs) that may be reported in the full manuscript. Details not reported in the abstract are not inferred here.