Cancer death rates remain highest among Black individuals vs. other racial, ethnic groups
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Despite a decrease in cancer mortality among Black individuals between 1999 and 2019, cancer death rates remained highest among Black men and women compared with any other racial and ethnic group.
The findings, published in JAMA Oncology, indicate a need for targeted interventions to eliminate social inequalities that contribute to higher cancer mortality among Black individuals, researchers noted.
Rationale and methods
“Cancer is the second leading cause of mortality in the United States, with more than 600,000 cancer deaths estimated for 2022,” Wayne R. Lawrence, DrPH, MPH, cancer prevention fellow in the division of cancer epidemiology and genetics at NCI, told Healio. “Despite the steady decline in cancer mortality per year, studies have reported that Black individuals continue to bear a higher cancer burden compared with other racial/ethnic groups.”
Lawrence and colleagues sought to examine national trends in cancer mortality between 1999 and 2019 among Black individuals according to demographic characteristics and to compare cancer mortality in 2019 among Black individuals with that of other racial/ethnic groups. They pooled data from U.S. death certificates and included all cancer deaths among individuals aged 20 years and older.
Key findings
Results showed 1,361,663 deaths due to cancer among Black individuals between 1999 and 2019. Rates of cancer mortality decreased steadily among Black individuals during this period, by approximately 2% per year, with a more rapid decrease among men (average annual percent change [AAPC] = 2.6%; 95% CI, 2.6 to 2.6) compared with women (AAPC = 1.5%; 95% CI, 1.7 to 1.3). However, Black men and women continued to experience higher rates of cancer mortality in 2019 compared with any other racial/ethnic group.
Researchers observed significant decreases in lung cancer mortality among men (AAPC = 3.8%; 95% CI, 4 to 3.6) and stomach cancer among women (AAPC = -3.4%; 95% CI, 3.6 to 3.2). Moreover, both men and women experienced the largest absolute decreases in lung cancer mortality (men, 78.5/100,000 population; women, 19.5/100,000 population).
Conversely, researchers observed significant increases in liver cancer mortality among men (AAPC = 3.8%; 95% CI, 3-4.6) and women (AAPC = 1.8%; 95% CI, 1.2-2.3) aged between 65 and 79 years. They additionally observed an increasing trend in uterine cancer mortality among women aged 35 to 49 years (AAPC = 2.9%; 95% CI, 2.3-2.6), 50 to 64 years (AAPC = 2.3%; 95% CI, 2-2.6) and 65 to 79 years (AAPC = 1.6%; 95% CI, 1.2-2).
Implications
Clinicians must be aware that many of the causes of racial disparities in cancer death rates are primarily systemic and preventable, Lawrence said.
“For instance, Black patients are more likely to experience poor patient-physician interaction, longer referrals, delay in treatment, less frequent physician follow-up, greater medical mistrust, and underuse of treatment and health care system failure, which are all mutable factors,” Lawrence said.
The steady decline in overall cancer death rates among Black individuals likely reflects advances in cancer prevention, detection and treatment, as well as population changes in exposure to cancer risk factors in the U.S., he added.
“However, despite the decrease in cancer mortality rates, Black individuals continue to have the highest mortality rate compared with other racial/ethnic groups, highlighting the need to address the pervasiveness of this longstanding racial inequity. Reducing racial/ethnic disparities in cancer mortality will require equitable access to cancer prevention, early diagnosis, and timely and guideline-adherent, high-quality care throughout the cancer control continuum,” Lawrence said.
Greater research emphasis must be placed on understanding the contribution of social inequities to higher cancer mortality rates among Black individuals, he added.
“For instance, examining why Black individuals are more likely to reside in neighborhoods with poor accessibility to a cancer specialist, to see a physician with lower access to clinical resources, and to reside in communities with greater exposure to environmental hazards linked to cancer risk,” Lawrence said. “One cause for concern is the disproportionate effect of COVID-19 on access to cancer-related medical care in Black communities in the U.S., such as a larger decline in breast cancer screening among Black women compared with white women. These factors could cause the decline in cancer death rates among Black individuals to slow in coming years. Further research is also needed to examine the impact of COVID-19 on cancer prevention, treatment and survival, as well as barriers to care among Black men and women.”
For more information:
Wayne R. Lawrence, DrPH, MPH, can be reached at NCI/NIH, 9609 Medical Center Drive, Bethesda, MD 20850; email: wayne.lawrence@nih.gov.
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