Residential Racial and Economic Segregation Associated with Cancer Mortality

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Residential Racial and Economic Segregation Associated with Cancer Mortality    

Jim Windell


           More than 80% of large metropolitan areas in the United States were more segregated in 2019 than they were in 1990. That is according to a recent analysis of residential segregation.

           While the U.S. has become more diverse over time, this has tended to obscure the persistence of segregation. Of course, most cities aren’t all-white, all-Black, or all-Latino, but within metropolitan areas, the different races are clustered in segregated neighborhoods.

           One study found that Detroit is the most segregated city in the U.S., but other highly segregated cities include Newark, Chicago, Milwaukee and Cleveland. The COVID-19 pandemic demonstrated the consequences of residential segregation as African Americans living in segregated cities, like Detroit and Chicago, died at a higher rate than people of other races in the same cities.

           To learn more about the consequences of segregated housing, the Index of Concentration at the Extremes (ICE), which was designed to reveal the extent to which an area’s residents are concentrated into groups at the extremes of deprivation and privilege, was used in a new study to show the health effects of residential racial and economic segregation. This new study led by researchers at the American Cancer Society (ACS) and Clemson University looked at cancer mortality at the county level in the U.S.

           In this study, published recently in the Journal of the American Medical Association (JAMA) Oncology, researchers examined county-level sociodemographic data linked with mortality data from the U.S. Census Bureau and the National Center for Health Statistics from 2015-2019. The scientists found that residential racial and economic segregation, measured by the ICE, was associated with cancer mortality at the county level. More specifically, the results showed the age-adjusted mortality rate ratio (ARR) of all cancers and indicated that segregation was associated with increased mortality. Lung cancer mortality had the strongest association with segregation – likely due to the cumulative effects of higher incidence from exposure to risk factors such as smoking and air pollution, less early detection through screening and early evaluation of signs and symptoms, and a lower survival rate due to limited access to quality cancer care associated with segregation. 

           The most segregated communities had a 20% higher mortality rate for all cancer types combined. The association was strongest for lung cancer with a 50% higher mortality in the most segregated counties. 

           According to Dr. Xuesong Han, scientific director of health services research at the American Cancer Society and senior author of the study, “Many people living in low-income minority households have less access to employment opportunities, transportation, education, and health care and are more likely to experience worse health outcomes. These findings show it is imperative we continue to look for ways to increase access to cancer prevention and early detection wherever possible to reduce disparities in cancer outcomes.”

           “In the past decades, most of the cancer prevention and control efforts targeted individual-level risk factors,” said Dr. Lu Zhang, Department of Public Health Sciences at Clemson University and lead author of the study. “In the future, more efforts are needed to remove structural risk factors and intervene on the intermediate factors to reduce the impact of segregation on health outcomes.”

           To read the original article, find it with this reference:

Zhang, L., Gong, R., Shi, L., et al. (2022). Association of Residential Racial and Economic Segregation with Cancer Mortality in the US. JAMA Oncology.  doi:10.1001/jamaoncol.2022.5382


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