County socioeconomic status and premature mortality from cancer in the United States

There are consistent data demonstrating socioeconomic status (SES) is associated with cancer survivorship among older adults, but research on the relationship between area-level SES and risk of premature mortality from cancer remains not well understood. This study investigated the association between county-level SES and premature mortality from cancer. Demographic characteristics and causes of death were ascertained from the national death certificate data for years 2016–2020. Premature cancer death was defined as cancer mortality between ages 25–64. County SES was calculated using the Yost Index and categorized into distribution-based quintiles (1 =lowest SES, 5=highest SES). To calculate the mortality-adjusted rate ratios (aRR) and corresponding 95 % confidence intervals (95 %CI) for the associations between county SES and cancer, we performed multivariable linear mixed models, adjusting for confounders. A total of 3143 counties were included. The age-adjusted mortality rates of all cancers combined were 107.6, 98.4, 88.6, 81.1, and 66.7 per 100,000 population for the 5 SES quintiles, respectively. Compared with high SES counties, low SES counties had a 58 % greater premature cancer mortality rate (aRRquintile 1 vs.5 =1.58, 95 %CI: 1.55–1.60). Similar associations were observed when stratified by sex, though risk was greatest among men ([aRRwomen=1.48, 95 %CI: 1.45–1.52]; [aRRmen=1.66, 95 %CI: 1.62–1.70]). Among leading cancer types, the association was greatest for lung cancer mortality for the lowest SES counties (aRR=2.03; 95 %CI: 1.98–2.08). Our findings demonstrate that lower SES counties are at greater risk of premature mortality from cancer. Place-based interventions should target the socioeconomic environment across the cancer control continuum. •Premature cancer mortality rates increase as county SES decrease.•Premature mortality rates were greatest for lung cancer in the lowest SES counties.•Men had a higher rate of premature cancer mortality than women in low SES counties.