Journal
AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume -, Issue -, Pages -Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwad194
Keywords
Alaska Natives; American Indians; cancer incidence; health disparities; social determinants of health; Social Vulnerability Index
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This study examines the impact of social determinants of health on the incidence rates of gastrointestinal cancer among AI/AN populations in the United States. The results indicate higher cancer rates among AI/AN populations in areas with higher social vulnerability. Disparities between AI/AN and White populations persist even after taking social vulnerability into account.
Social determinants of health and associated systems, policies, and practices are important drivers of health disparities. American Indian and Alaska Native (AI/AN) populations in the United States have elevated incidence rates of stomach, liver, and colorectal cancers compared with other racial/ethnic groups. In this study, we examined incidence rates of 3 types of gastrointestinal cancer among non-Hispanic AI/AN (NH-AI/AN) and non-Hispanic White (NHW) populations by geographic region and Social Vulnerability Index (SVI) score. Incident cases diagnosed during 2010-2019 were identified from population-based cancer registries linked with the Indian Health Service patient registration databases. Age-adjusted incidence rates (per 100,000 population) for stomach, liver, and colorectal cancers were compared within NH-AI/AN populations and between the NH-AI/AN and NHW populations by SVI score. Rates were higher among NH-AI/AN populations in moderate- and high-SVI-score counties in Alaska, the Southern Plains, and the East than in low-SVI counties. Incidence rates among NH-AI/AN populations were elevated when compared with NHW populations by SVI category. Results indicated that higher social vulnerability may drive elevated cancer incidence among NH-AI/AN populations. Additionally, disparities between NH-AI/AN and NHW populations persist even when accounting for SVI. Exploring social vulnerability can aid in designing more effective interventions to address root causes of cancer disparities among AI/AN populations.
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