Cancer Health Disparities in Tarrant County

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1 Cancer Health Disparities in Tarrant County A presentation to the Tarrant County Cancer Disparities Coalition May 3, 07 Marcela Gutierrez, LMSW Assistant Professor in Practice UTA School of Social Work Betty Tonui, MSW PhD Student UTA School of Social Work

2 What are Cancer Health Disparities? Adverse differences in cancer incidence (new cases), cancer prevalence (all existing cases), cancer death (mortality), cancer survivorship, and burden of cancer or related health conditions that exist among specific population groups in the United States In other words--a cancer health disparity exists if simply being part of a certain group means that you are more likely to get cancer, die from cancer, and experience significant work and life disruptions from cancer. Source: National Cancer Institute

3 WHO is impacted by Cancer Health Disparities? Groups that experience cancer health disparities are typically characterized by. age disability education ethnicity gender geographic location income race People who are poor, lack health insurance, and have limited or no access to effective health care are often impacted more severely by cancer than the general population

4 How do social and economic factors impact a person s risk of cancer? Individuals may be at risk of cancer because of genetics or personal health choices such tobacco or alcohol use, dietary choices, physical inactivity, or obesity/overweight. However, differences between groups are strongly influenced by social and economic factors such as being uninsured/underinsured, low income, education level, occupation, social status in the community, neighborhood poverty, etc.

5 Tobacco use exists among people of all social classes (individual health behavior), but tobacco companies market more heavily in low-income neighborhoods (socioeconomic factor).

6 Why is RACE important for studying health disparities? Differences in health are particularly pronounced for racial/ethnic groups such as African-Americans and Latinos, Many of these differences persist even when you compare groups of similar socioeconomic status.

7 Which types of cancers are most impacted by health disparities? Researchers have found significant evidence of health disparities in the following five types of cancer: Breast Cervical Prostate Cervical Lung

8 e.g. uninsured status Racial or class discrimination, lack of access to health care Financial, physical, and cultural beliefs about health and healthcare Gerend, M. A., & Pai, M. (008). Social determinants of Black-White disparities in breast cancer mortality: a review. Cancer Epidemiology and Prevention Biomarkers, 7(),

9 WHO IS MOST AT RISK BASED ON THEIR HEALTH BEHAVIORS? Cancer Health Disparities in PRIMARY PREVENTION

10 Percentage of People with Cancer Risk Factors for Tarrant County, Texas & US Adults Aged 8 Years and Older, 05 Risk Factors Tarrant County Texas United States Overweight (BMI ) 36.4 ( ) 36. ( ) 35.5 Obesity (BMI 30.0) 9.6 ( ) 3. ( ) 9.8 Did not meet physical activity recommendations3 8.8 ( ) 8.0 ( ) 79.7 Less than daily fruit 45. ( ) 4.7 ( ) 39.7 Less than daily vegetable.7 ( ) 9.6 (8.-.0). Diabetes diagnosis 0.6 (9.4-.9). (0.3-.0) 9.9 Tobacco use (current) 7.6 ( ) 5. ( ) 7.5 Binge drinker 6. (4.4-8.) 6. ( ) 6.3 Data source: Tarrant County Behavioral Risk Factor Surveillance System, Tarrant County Public Health 05, Age-adjusted Center of Diseases Control and Prevention (BRFSS, 05); Age-adjusted for texas 3 Did not meet both aerobic and muscle strengthening recommendations

11 Percentage of People with Cancer Risk Factors in Tarrant County, by Race/Ethnicity, 05 Risk Factors All Races White Black Hispanic Asian Other/ Multiracial Overweight (BMI ) 36.4 ( ) 35.3 ( ) 33.7 ( ) 43.0 ( ) 3.4 ( ) 30.5 ( ) Obesity (BMI 30.0) 9.6 ( ) 8. ( ) 38.0 ( ) 9.9 ( ) ( ) Did not meet physical activity recomm. 8.8 ( ) 8. ( ) 85. ( ) 83.6 ( ) 79.6 ( ) 7.0 ( ) Less than daily fruit 45. ( ) 46. ( ) 50.8 ( ) 4.9 ( ) 34.0 ( ) 44.3 ( ) Less than daily vegetable.7 ( ) 0. (7.6-3.) 3.9 ( ) 0.8 (6.-6.) ( ) Diabetes diagnosis 0.6 (9.4-.9) 8.6 ( ) 5.8 (.-0.).4 (9.5-6.) ( ) Tobacco use (current) 7.6 ( ) 7. ( ) 0.6 ( ) 6.4 (.0-.9) ( ) Binge drinker 6. (4.4-8.) 6.5 (4.-9.) 3.6 (9.5-9.) 8.6 ( ) ( ) Data source: Tarrant County Behavioral Risk Factor Surveillance System, Tarrant County Public Health 05 Did not meet both aerobic and muscle strengthening recommendations

12 Percentage of People with Cancer Risk Factors in Tarrant County, by Education, 05 Risk Factors All Levels < High School High School or GED Tech/ Some College College Degree Overweight (BMI ) 36.4 ( ) 4.9 ( ) 36.4 (3.0-4.) 34. ( ) 36.0 ( ) Obesity (BMI 30.0) 9.6 ( ) 9.6 ( ) 30.8 ( ) 30.0 (6.-34.) 8. ( ) Did not meet physical activity recommendations4 8.8 ( ) 9. ( ) 85.3 ( ) 79.5 ( ) 79. ( ) Less than daily fruit 45. ( ) 4.3 ( ) 5.8 ( ) 48.0 ( ) 38.6 ( ) Less than daily vegetable.7 ( ) 4.7 (8.-3.6) 4.6 (0.6-9.). ( ) 7. (3.9-.) Diabetes diagnosis 0.6 (9.4-.9) 8.3 ( ).9 ( ) 8.8 (7.0-.) 6.9 ( ) Tobacco use (current) 7.6 ( ) 7.8 ( ) 5.0 (.-9.3) 6.7 ( ) 6.4 ( ) Binge drinker 6. (4.4-8.) 7. (.0-4.) 8. (4.6-.4) 7.0 ( ) 3.0 ( ) Data source: Tarrant County Behavioral Risk Factor Surveillance System, Tarrant County Public Health 05

13 Percentage of People with Cancer Risk Factors in Tarrant County, by Income, 05 Risk Factors All Levels Low (<$5K) Middle ($5K - <$50K) High ($50K - <$75K) Highest ($75K+) Overweight (BMI ) 36.4 ( ) 3.3 ( ) 37.9 ( ) 36.9 ( ) 37.0 ( ) Obesity (BMI 30.0) 9.6 ( ) 35.7 ( ) 9.4 ( ) 7.6 ( ) 30.8 ( ) Did not meet physical activity recommendations4 8.8 ( ) 88.7 ( ) 8.5 ( ) 79.9 ( ) 78. ( ) Less than daily fruit 45. ( ) 47.4 ( ) 45.9 ( ) 44.6 ( ) 4. ( ) Less than daily vegetable.7 ( ) 5.5 ( ).8 ( ) 5.3 (9.5-3.) 5.8 (.6-9.7) Diabetes diagnosis 0.6 (9.4-.9) 6. ( ).6 (9.7-6.) 7.6 ( ) 6.3 ( ) Tobacco use (current) 7.6 ( ) 5.9 (.-3.).7 ( ) 7.4 (.5-3.6) 7.9 ( ) Binge drinker 6. (4.4-8.) 3.4 (0.-7.5) 5.8 (.0-0.6) 9.6 ( ) 8.3 (5.0-.0) Data source: Tarrant County Behavioral Risk Factor Surveillance System, Tarrant County Public Health 05

14 Health Disparities in Cancer Risk Behaviors Tarrant County has a similar overall profile as Texas and the United States. Within Tarrant County, Blacks are associated with higher rates of obesity, low vegetable intake, and diabetes compared to Whites.

15 WHO IS GETTING SCREENED FOR CANCER? Cancer Health Disparities in EARLY DETECTION

16 Percentage of People Getting Screened for Cancer in Tarrant County, Texas & US, 04/05 Cancer Site3 Tarrant County Texas United States Breast (Mammogram within past two years, Women 50+) 83. ( ) 74.4 ( ) 75.6 Cervical (Pap test within past 3 years, women -65 with intact cervix) 83.5 ( ) 77.7 ( ) 75. Prostate (Men 40+ who had a PSA test in past years) 4.8 ( )4 4.9 ( ) 4.8 Colorectal (Adults 50+ who had a blood stool test within past years) 9.6 (6.3-.8)4 3.6 (.-4.9).8 Lung5 Data source: Tarrant County Behavioral Risk Factor Surveillance System, Tarrant County Public Health 04; Age-adjusted. CDC BRFSS 04; Texas data is age-adjusted 3 Breast and cervical are female-only; Prostate is male only; Lung and Colorectal is male and female combined 4Prostate and colorectal- CDC BRFSS 04 MMSAs- Forth-Worth & Arlington 6Not measured by the BRFSS

17 Percentage of Cancer Screening Rates in Tarrant County by Race/Ethnicity Cancer Site All Races Hispanic Asian Black White Other/ Multiracial Breast (Mammogram within past two years, Women 50+) 83. ( ) 79.0 ( ) 86.3 ( ) 83.0 ( ) Cervical (Pap test within past years, women -65 with intact ( ) cervix) 75.3 ( ) 90.4 ( ) 85.7 ( ) Prostate (Men 40+ who had a PSA test in past years) ( ) 35.7 (.-53.5) 4.3 ( ) 59.0 ( ) 6.6 ( ) Colorectal (Adults 50+ who had a blood stool test within past years)3.9 (.-4.9) 6. (3.4-.0) 5.9 ( ) 3. (.-5.4) 5.4 ( ) Lung4 Data source: Tarrant county Behavioral Risk Factor Surveillance System, Tarrant County Public Health 05 Breast and cervical are female-only; Prostate is male only; Lung and Colorectal is male and female combined 3BRFSS Not measured by the BRFSS --- Number is too small to be calculated.

18 Percentage of Cancer Screening Rates in Tarrant County by Education Cancer Site All Levels < High School High School or GED Tech/ Some College College Degree 83. ( ) 78.8 ( ) 8.3 ( ) 8.9 ( ) 88.9 ( ) Cervical (Pap test within past 3 years, women -65 with intact cervix) 83.5 ( ) 76.6 ( ) 85.5 ( ) 88. ( ) Prostate (Men 40+ who had a PSA test in past years) ( ) 5.4 (4.-4.5) 48.4 ( ) 55.3 ( ) 58.8 ( ) Colorectal (Adults 50+ who had a blood stool test within past years)3.9 (.-4.9) 8.9 ( ) 3.7 ( ) 3. ( ) 3.3 ( ) Lung4 Breast (Mammogram within past two years, Women 50+) Data source: Tarrant county Behavioral Risk Factor Surveillance System, Tarrant County Public Health 05 Breast and cervical are female-only; Prostate is male only; Lung and Colorectal is male and female combined 3BRFSS Not measured by the BRFSS --- Number is too small to be calculated.

19 Health Disparities in Early Detection Compared to Texas and the US, Tarrant County has higher rates of breast cancer screening. Within Tarrant County, Hispanics have lower rates of prostate and colorectal cancer screening than Whites. Within Tarrant County, people with a high school diploma or less have lower rates of breast, cervical, prostate and colorectal screening than people with more than a high school diploma.

20 WHO IS GETTING DIAGNOSED WITH CANCER? Cancer Health Disparities in INCIDENCE

21 Cancer Incidence Rates for Adults 8+, comparing Tarrant County,Texas and US Cancer Site Tarrant County3 Texas3 United States4 Breast (female) 8.5 (5.4-.7).5 (0.7-.3) 4.9 Cervical 8.5 ( ) 9. ( ) 7.4 Prostate 4. ( ) 99.5 ( ) 9.8 Colorectal 38. ( ) 38.6 ( ) 40. Lung 58.7 ( ) 54.8 ( ) 55.8 All rates are per 00,000 and age-adjusted to 000 U.S. Standard Population Breast and cervical Female only Prostate Male only 3 Data source:texas Cancer Registry ( SEER*Stat Database Data source National Cancer Institute; SEER

22 Cancer Incidence Rates for Adults 8+, in Tarrant County, by Race Cancer Site3 Breast (female) Cervical Prostate Colorectal Lung Incidence Incidence Incidence Incidence Incidence All Races 8.5 (5.4-.7) 8.5 ( ) 4. ( ) 38. ( ) 58.7 ( ) White 7.4 ( ) 8.3 (7.-9.5) 0.5 ( ) 37.3 ( ) 64.5 ( ) Black 7.4 ( ) 8.8 (6.6-.5) 87.9 ( ) 5. ( ) 66.7 ( ) Hispanic 8.7 ( ).6 ( ) 9.7 (8.9-0.) 3.8 ( ) 5.6 (.-9.6) Asian 63.0 ( ) 6.3 ( ) 30. ( ) 3.5 ( ) 37.0 ( ) All rates are per 00,000 and age-adjusted to 000 U.S. Standard Population Data Source: Texas Cancer Registry 3 Breast and cervical are female-only; Prostate is male only; Lung and Colorectal is male and female combined _ (cannot be calculated)

23 Health Disparities in Incidence of Cancer Compared to Texas and the US, people in Tarrant County are most likely to be diagnosed with lung cancer. In Tarrant County, more people overall are diagnosed with breast and prostate cancer as compared to cervical, lung or colorectal cancer. Black men are.7 times more likely than White men to get prostate cancer, and Prostate cancer and colorectal cancer is much more prevalent among Blacks than any other racial group. Breast cancer (female) and lung cancer are diagnosed at about the same rates among Whites and Blacks. Cervical cancer is more prevalent among Hispanics than Whites.

24 AT WHAT STAGE DO PEOPLE GET DIAGNOSED? Cancer Health Disparities in STAGE OF DIAGNOSIS

25 Why does it matter when people get diagnosed? Research shows that individuals from medically underserved populations are more likely to be diagnosed with late-stage diseases that might have been treated more effectively or cured if diagnosed earlier. In Situ Localized Early Stage Regional Distant Late Stage Unknown

26 Percentage of Late-Stage Cancer Diagnoses by Cancer Site, Comparing Tarrant County, Texas and the United States Cancer Site3 Tarrant County Texas United States Breast (female) Cervical Prostate Colorectal Lung Regional and distant stage combined Data sources:texas Cancer Registry ( (00-04); SEER*Stat Database (007-03) 3 Breast and cervical are female-only; Prostate is male only; Lung and Colorectal is male and female combined -- Unavailable

27 Percentage of Late-Stage Cancer Diagnoses in Tarrant County by Cancer Site and Race/Ethnicity, Cancer Site3 All Races White Hispanic Asian Black Breast (female) Cervical Prostate Colorectal Lung Regional and distant stage combined Data source: Texas Cancer Registry 3 Breast and cervical are female-only; Prostate is male only; Lung and Colorectal is male and female combined

28 Health Disparities in Stage of Cancer Diagnosis Compared to Texas and the US, Tarrant County tends to catch cancer in its earlier stages. Within Tarrant County, Hispanics are most likely to be diagnosed with late-stage cervical or colorectal cancer than other racial/ethnic group Within Tarrant County, Blacks are most likely to be diagnosed with late-stage breast, prostate or lung cancer than other racial/ethnic groups

29 WHO IS DYING FROM CANCER? Cancer Health Disparities in PRIMARY PREVENTION

30 Cancer Mortality Rates in Tarrant County, Texas and US, Cancer Site Tarrant County3 Texas3 United States4 Breast (female) 0.3 (9.0-.7) 0.3 ( ). Prostate 9.5 (7.8-.3) 8.6 (8.-9.0) 0. Cervical 3.0 (.5-3.5).8 (.6-.9).3 Colorectal 4.8 ( ) 4.7 ( ) 4.8 Lung 4.3 ( ) 40.4 ( ) 44.7 All rates are per 00,000 and age-adjusted to 000 U.S. Standard Population Breast and cervical are female-only; Prostate is male only; Lung and Colorectal is male and female combined 3 Data source:texas Cancer Registry ( SEER*Stat Database; 4 Data source: National Cancer Institute SEER

31 Comparison of Cancer Incidence and Mortality Rates in Tarrant County, Cancer Site3 Incidence Death Breast (female) 8.5 (5.4-.7) 0.3 (9.0-.7) Prostate 4. ( ) 9.5 (7.8-.3) Cervical 8.5 ( ) 3.0 (.5-3.5) Lung 38. ( ) 4.8 ( ) Colorectal 58.7 ( ) 4.3 ( ) All rates are per 00,000 and age-adjusted to 000 U.S. Standard Population Data source: Texas Cancer Registry ( SEER*Stat Database, Mortality - Texas, , statewide, Texas Department of State Health Services (created 03/3/07). 3 Breast and cervical are female-only; Prostate is male only; Lung and Colorectal is male and female combined

32 Comparison of Cancer Incidence and Mortality Rates in Tarrant County by Race, Cancer Site3 Breast(female) Race Incid. Death All Races 8.5 (5.4-.7) 0.3 (9.0-.7) White 7.4 ( ) 0.7 (9.-.4) Black 7.4 ( ) 7.8 ( ) Hispanic 8.7 ( ) 3.0 (0.-6.4) Asian 63.0 ( ) 8.6 (4.8-4.) All rates are per 00,000 and age-adjusted to 000 U.S. Standard Population Data Source: Texas Cancer Registry 3 Breast and cervical are female-only; Prostate is male only; Lung and Colorectal is male and female combined _ (cannot be calculated)

33 Comparison of Cancer Incidence and Mortality Rates in Tarrant County by Race, Cancer Site3 Prostate Race Incid. Death All Races 4. ( ) 9.5 (7.8-.3) White 0.5 ( ) 8. (6.4-0.) Black 87.9 ( ) 39. ( ) Hispanic 9.7 (8.9-0.) 7.0 (.-.8) Asian 37.0 ( ) --- All rates are per 00,000 and age-adjusted to 000 U.S. Standard Population Data Source: Texas Cancer Registry 3 Breast and cervical are female-only; Prostate is male only; Lung and Colorectal is male and female combined _ (cannot be calculated)

34 Comparison of Cancer Incidence and Mortality Rates in Tarrant County by Race, Cancer Site3 Cervical Race Incid. Death All Races 8.5 ( ) 3.0 (.5-3.5) White 8.3 (7.-9.5).8 (.-3.5) Black 8.8 (6.6-.5) 3.4 (.-5.) Hispanic.6 ( ) 5.7 (3.7-8.) Asian 6.3 ( ) --- All rates are per 00,000 and age-adjusted to 000 U.S. Standard Population Data Source: Texas Cancer Registry 3 Breast and cervical are female-only; Prostate is male only; Lung and Colorectal is male and female combined _ (cannot be calculated)

35 Comparison of Cancer Incidence and Mortality Rates in Tarrant County by Race, Cancer Site3 Colorectal Race Incid. Death All Races 38. ( ) 4.8 ( ) White 37.3 ( ) 4.7 ( ) Black 5. ( ) 3. ( ) Hispanic 3.8 ( ) 0. (8.0-.5) Asian 30. ( ) 0.9 ( ) All rates are per 00,000 and age-adjusted to 000 U.S. Standard Population Data Source: Texas Cancer Registry 3 Breast and cervical are female-only; Prostate is male only; Lung and Colorectal is male and female combined _ (cannot be calculated)

36 Comparison of Cancer Incidence and Mortality Rates in Tarrant County by Race, Cancer Site3 Colorectal Race Incidence Death Male Female Male Female All Races 44.7 ( ) 33. ( ) 8.4 ( ). (.-3.3) White 44.4 ( ) 3.8 ( ) 8. (6.5-0.).0 ( ) Black 58.8 ( ) 48.4 ( ) 9.6 (3.-37.) 9. ( ) Hispanic 4.4 ( ) 6. ( ) 4.0 (0.-8.7) 7. ( ) Asian 30.8 ( ) 9. (.-38.8) 3. (7.3-.7) 9.3 (5.-5.) All rates are per 00,000 and age-adjusted to 000 U.S. Standard Population Data Source: Texas Cancer Registry 3 Breast and cervical are female-only; Prostate is male only; Lung and Colorectal is male and female combined _ (cannot be calculated)

37 Comparison of Cancer Incidence and Mortality Rates in Tarrant County by Race, Cancer Site3 Lung Race Incid. Death All Races 58.7 ( ) 4.3 ( ) White 64.5 ( ) 46.7 ( ) Black 66.7 ( ) 47. ( ) Hispanic 5.6 (.-9.6) 7. (4.-0.6) Asian 3.5 ( ) 4.6 ( ) All rates are per 00,000 and age-adjusted to 000 U.S. Standard Population Data Source: Texas Cancer Registry 3 Breast and cervical are female-only; Prostate is male only; Lung and Colorectal is male and female combined _ (cannot be calculated)

38 Health Disparities in Cancer Incidence AND Mortality Within Tarrant County: White women and Black women have similar rates of breast cancer, yet Black women are.3 times more likely to die from breast cancer. Black men are. times more likely than White men to die from prostate cancer. Hispanic women are.5 times as likely than White women to be diagnosed with cervical cancer, and times as likely to die from it. Black men and women are at least.3 times as likely than Whites to get colorectal cancer, and.6 times as likely to die from it. Blacks and Whites have similar rates of lung cancer incidence and mortality.

39 RECAP: WHAT DOES THE DATA TELL US about tarrant county? Interpreting Health Disparities Data

40

41 SO WHAT CAN WE DO ABOUT IT? How do we take action?

42 What can we do about Cancer Health Disparities?

43 FORTHCOMING...

44 Round Robin: WITHIN TARRANT COUNTY.... What are the three biggest challenges to individuals participating in programs and services for people with cancer (and their families)?. What are the three biggest challenges to providers participating in these programs and services? 3. What are three things the TCCDC should do to address cancer health disparities?

45

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