Cancer Health Disparities in Kansas

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Cancer Health Disparities in Kansas
By Henri Ménager, Epidemiologist Cancer
Prevention and Control Program Kansas Department
of Health Environment
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Leading Causes of Death in Kansas
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Cancer Facts

• Cancer is the 2nd cause of death in Kansas
• Each year
• About 12,200 people are diagnosed with cancer
• About 5,300 people die with cancer
• Cancer affects all people regardless of their
  race or ethnicity
• The burden of cancer is greater for the poor, the
  ethnic minorities, and for the uninsured.

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Cancer Disparities Defined

• Health disparities are differences in the
  incidence, prevalence, mortality, and burden of
  cancer and related adverse health conditions that
  exist among specific population groups in the
  United States. (NIH)
• Disparities can be related to race, ethnicity,
  age, sex, education, income, place of residence,
  disability status, and sexual orientation.
• Cancer disparities vary with the site of cancer.

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What Are Some National Patterns?

• Hispanics are less likely to receive chemotherapy
  than non-Hispanic Whites
• African Americans have a higher mortality rate
  than non-Hispanic Whites for colorectal cancer
• Black and Hispanic children are more likely to
  lack health insurance and a usual source of care
  than non-Hispanic White children
• White women are slightly more at risk for breast
  cancer
• African-American Women are 1.7 times more likely
  to die from breast cancer than others

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Incidence
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Age-Adjusted Rates of All Cancer Sites Combined
Per 100,000
Year of diagnosis
Rates are per 100,000 and are age-adjusted to the
2000 U.S. Standard Population
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Leading Cancers in Kansas
Men6,242
Women5,747
Breast 31 Colon rectum
12 Lung bronchus 12 Uterine
corpus 5 Non-Hodgkin 5
lymphoma Melanoma of skin
4 Thyroid 3 Ovary
3 Pancreas
2 Urinary bladder 2 All Other Sites
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Prostate 30 Lung bronchus 16 Colon
rectum 12 Urinary bladder 6 Melanoma of
skin 4 Non-Hodgkin
lymphoma 4 Kidney 3 Oral Cavity 3 Leukemia 3
Pancreas 2 All Other Sites 17
Based on 2003 annual report and excludes basal
and squamous cell skin cancers and in situ
carcinomas except urinary bladder.
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Age-adjusted Rate of Female Breast
Cancer 2001-2003
Rate per 100,000
226
5,363
76
Rates are per 100,000 and are age-adjusted to the
2000 U.S. Standard Population Race and ethnicity
are not mutually exclusive
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Female Breast Cancer Stage at Diagnosis,
2001-2003

n 5,362 n 226
n 76 n 148
Race and ethnicity are not mutually exclusive
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Percent Distant Stage Female Breast Cancers
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Distribution of Minority Population
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Age-adjusted Rate of Prostate Cancer 2001-2003
Rate per 100,000
272
5181
68
Rates are per 100,000 and are age-adjusted to the
2000 U.S. Standard Population Race and ethnicity
are not mutually exclusive
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Prostate Cancer - Stage at Diagnosis 2001-2003

n 5,181 n 272
n 68 n 327
Race and ethnicity are not mutually exclusive
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Percent Distant Stage Prostate Cancers
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Age-adjusted Rate of Colorectal Cancer 2001 - 2003
Per 100,000
201
4095
72
Rates are per 100,000 and are age-adjusted to the
2000 U.S. Standard Population Race and ethnicity
are not mutually exclusive
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Colorectal Cancer - Stage at Diagnosis 2001-2003

n 4,023 n 201
n 72 n 113
Race and ethnicity are not mutually exclusive
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Percent Distant Stage Colorectal Cancers
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Age-adjusted Rate of Melanoma of Skin 2001 - 2003
Rate per 100,000
1305
9
2
Rates unstable
Rates are per 100,000 and are age-adjusted to the
2000 U.S. Standard Population Race and ethnicity
are not mutually exclusive
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Melanoma of Skin Stage at Diagnosis, 2001-2003

n 1,305 n 2
n 9 n 149
Race and ethnicity are not mutually exclusive
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Percent Distant Stage Melanoma Cancers
MelanomaDistant Stage Percent
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Age-adjusted Rate of Lung Bronchus Cancer 2001
- 2003
Rate per 100,000
240
4932
64
Rates are per 100,000 and are age-adjusted to the
2000 U.S. Standard Population Race and ethnicity
are not mutually exclusive
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Lung Bronchus Cancer Stage at Diagnosis,
2001-2003

n 4,932 n 240
n 64 n 60
Race and ethnicity are not mutually exclusive
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Cancer of Cervix, Stage at Diagnosis 2001-2003

n 276 n 27 n
23 n 23
Race and ethnicity are not mutually exclusive
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Mortality
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Overall Mortality by Race and Ethnicity
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African-Americans

• Overall, African-Americans have a higher
  incidence rate and a higher mortality rate than
  the rest of the Kansas population.
• Nationwide, African-American males develop
  cancer 15 more frequently than white males.
• Compared to other females, African-American
  females have the highest incidence rate for colon
  cancer
• African-American females have the highest
  mortality rate for breast cancer

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Adjusted to 2000 US Population. Source Kansas
Information for Communities
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Selected Health Risk Factors
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Risk Factors Smoking
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Risk Factors Obesity
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Lack of Insurance
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Place of Residence
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Education Level
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Cancer Among American Indians and Alaska Natives
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2000 CENSUS DATA

• KANSAS
• Don/Br/Jack 1,912
• Shawnee 1,980
• Douglas 2,561
• Sedgwick 5,041
• Wyandotte 1,175
• KS TOTAL 24,936

• MISSOURI
• Jack 3,168
• Clay 920
• St. L 1,717
• St. Ch 568
• Jeff 594
• MO TOTAL 25,076

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DEATH RATES
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LEADING CAUSES OF DEATH

• FEMALES MALES
• heart disease heart disease
• cancer injuries
• injuries cancer
• diabetes diabetes
• stroke liver dis./cirrhosis

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PRESIDENTS CANCER PANEL REPORT on NATIVE
AMERICANS

• population in which cancer occurs less
  frequently, but more often is fatal when compared
  to the rest of the population.
• Recommendation increased access to cancer
  screening and treatment
• March, 2004

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LEADING FATAL CANCER SITES

• FEMALES MALES
• lung lung
• breast colon
• colon prostate
• pancreas stomach
• ovary liver

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CERVICAL CANCER

• AI/AN women have the second highest mortality
  rate from cervical cancer of any racial/ethnic
  group in the U.S.
• Rates vary greatly geographically.
• Its preventable with Pap smears!

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CIGARETTE SMOKING

• SMOKERS Men Women
• AI/AN 34.1 37.9 31.3
• AFR-AM 26.7
• WHITES 25.3 27.4 23.3
• HISP 20.4
• -highest and heaviest in northern plains
• -among h.s. seniors, highest in AI/AN students
• CDC, 1998

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SEXUALLY TRANSMITTED DISEASES

• RATES
• HPV (human papillomavirus)
• CHLAMYDIA
• SYPHILIS
• HIV

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Percent Change in Minority Population (1990
2000)
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Kansas demographics are changing.

• From 1990 to 2000
• population increased by 8.6
• Non-White population increased by at least 40
  (from 10 to 14)
• Asian/Pacific Islanders increased in number and
  percentage of the total population from 31,750 to
  48,119 (51.6 inc.)
• Some other Race increased by 85.9
• In 2000 Census, 56,496 people claimed more than
  one race

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1990 2000 Changes Race
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1990 2000 Changes Ethnicity
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Data Issues

• Small population size
• Standardization for race and ethnicity data
  collection and sharing
• Data sharing between partners
• Insufficient data use by locals and minority
  communities
• Lack of data training
• Lack of resources
• Lack of interest and myths about data
• Lack of leadership
• Local participation in decision-making process
• Categorical funding

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Data Needs

• Site-specific prevalence rates
• Access to care data
• Transportation
• Survivorship data
• Labor statistics
• Cost analysis
• Data for subgroups with small numbers
• SEER and NPCR are great but

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Selected Data Sources
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United States Cancer Statistics 2002 Incidence
Data
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The Community Guide
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Cancer Intervention Best Practices
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USPSTF Homepage
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Kansas Cancer Registry
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BRFSS and HRS Data BRFSS website
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SEER
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RESOURCES

• Trends in Indian Health, 2000-2001
• E. Rhoades, American Indian Health,
• Johns Hopkins Univ. Press, 2000
• Duran, E.B., Native American Post-
• Colonial Psychology, SUNY, 1995
• www.ihs.gov

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Credits
Sue-Min Lai, Ph.D., MS, MBADirector, Kansas
Cancer Registry Professor, Preventive Medicine
Public Health University of Kansas Medical Center
Dee Ann DeRoin, MD,MPH American Indian Symposium
Kansas Health Institute Racial and Ethnic
Minority HealthDisparities in Kansas, A Data
Chartbook (2005)