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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Health".

Deadline for manuscript submissions: closed (31 January 2020) | Viewed by 17213

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Dr. Jennifer Moss

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Guest Editor

Penn State College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
Interests: cancer prevention; disparities; geography; rural/urban differences; social epidemiology; adolescent health; vaccination; tobacco use; cancer screening

Special Issue Information

Dear colleagues,

Efforts to prevent cancer incidence and mortality have made incredible progress over the last few decades. However, the progress in cancer prevention has not been experienced equally across the population, with significant disparities observed according to sociodemographic characteristics. Increasingly, researchers and policymakers have focused on the role of geography in the emergence of cancer health disparities, including regional variation, neighborhood characteristics, the built and social environment, and environmental exposures. To move the field forward, we need a more nuanced understanding of the independent and interactive effects of (1) multiple area-level characteristics, e.g., neighborhood rurality and employment; (2) compositional and contextual attributes, e.g., median household income and crime rate; and (3) multilevel variables, e.g., individual-level gender and the area-level poverty rate. For this Special Issue of the International Journal of Environmental Research and Public Health, we invite research papers, reviews, case reports, methodological papers, brief reports, and commentaries on geographic (e.g., neighborhood, region, rurality) diparities in the cancer control continuum (including prevention, detection, treatment, and survivorship). Epidemiologic and intervention studies on etiology, behaviors, incidence, mortality, quality of life, policy, and other factors relevant to cancer are welcome. International submissions encouraged.

Dr. Jennifer Moss
Guest Editor

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Keywords

Health disparities
Health equity and social justice
Cancer disparities
Cancer control continuum
Geographic disparities
Multilevel studies
Social determinants of health
Intersectionality
Interventions to reduce disparities
Community-based research

Published Papers (6 papers)

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Research

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20 pages, 1599 KiB

Open AccessArticle

Testing the Preliminary Validity of a Multidimensional Framework for Studying the Effects of Cancer Health Literacy on Cancer Screening Behaviors among Diverse Populations

by Margarita Echeverri, David Anderson, Jacqueline M. Haas, Marc E. Johnson, Friar Sergio A. Serrano and Anna María Nápoles

Int. J. Environ. Res. Public Health 2020, 17(9), 2987; https://doi.org/10.3390/ijerph17092987 - 25 Apr 2020

Cited by 5 | Viewed by 3328

Abstract

The objective of this study was to evaluate the applicability of a multidimensional framework to explore factors associated with cancer literacy and its effects on receiving cancer screenings among diverse populations. Based on the conceptual framework, we developed and pilot-tested the Multidimensional Cancer Literacy Questionnaire (MCLQ) among 1500 individuals (African Americans, Latinos and Whites) in Louisiana. Exploratory factor analysis was used to identify the MCLQ underlying structure and predominant factors explaining each of the dimensions in the model. A total of 82 items (explaining 67% of the total variance) in the MCLQ were grouped into 20 factors associated with three key dimensions related to cancer literacy. Preliminary validity of the MCLQ was supported: Cronbach alpha for the scale score was 0.89 and internal consistency reliability coefficients for each factor were all above 0.67. The Facilitators Domain included five factors (28 items) that may positively influence individuals to have early-detection cancer screenings. The Barriers Domain included seven factors (26 items) explaining aspects that may negatively influence individuals to have cancer screenings. The Cultural Domain included eight factors (28 items) related to aspects that influence positively or negatively individuals’ perceptions regarding cancer as a disease, screenings and treatments. A multidimensional framework to study cancer literacy, including cultural attitudes, beliefs and practices, as well as facilitators and barriers, among diverse populations, will increase understanding of factors influencing individuals’ approach to cancer prevention and screening. Results will inform further testing of the multidimensional framework and questionnaire. Full article

(This article belongs to the Special Issue Cancer Health Disparities)

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14 pages, 2148 KiB

Open AccessArticle

Characterization of Esophageal Cancer and Its Association with Influencing Factors in Guangzhou City, China

by Cheng Cui, Hang Dong, Hongyan Ren, Guozhen Lin and Lu Zhao

Int. J. Environ. Res. Public Health 2020, 17(5), 1498; https://doi.org/10.3390/ijerph17051498 - 26 Feb 2020

Cited by 3 | Viewed by 2286

Abstract

Epidemiological features of esophageal cancer (EC), as well as their associations with potential influencing factors in a city, have seldom been seldom explored on a fine scale. The EC death cases in Guangzhou city during 2012−2017 were collected to describe the epidemiological characteristics such as EC mortality rate (ECMR) and health-seeking behaviors of deaths. Potential influencing factors, including socioeconomic conditions (population density, gross domestic product density), medical resources, and ageing degree were also gathered for exploring their relationships with the epidemiological characteristics of EC. A total of 2,409 EC deaths were reported during 2012−2017 in Guangzhou with an age-standardized ECMR of 3.18/10⁵. The prevalence of EC in Guangzhou was spatially featured and was divided into three regions with obvious differentiated ECMR (ECMR of 6.41/10⁵ in region A, ECMR of 5.51/10⁵ in region B, ECMR of 2.56/10⁵ in region C). The street/town-level ECMR was spatially clustered in Guangzhou city, especially two clusters of streets/towns with high ECMR were highlighted in region A and B respectively. Meanwhile, demographic features including gender gap, death age, temporal interval between diagnosis and death, health-seeking behaviors were remarkably different among the three regions. Moreover, health-seeking behaviors (e.g., the proportion of hospital deaths) of the EC deaths were obviously influenced by medical institution occupancy rate and socioeconomic conditions at street/town level. In addition, the street/town-level ECMR was significantly associated with ageing degree across Guangzhou city (r = 0.466, p < 0.01), especially in region A (r = 0.565, p < 0.01). In contrast, the ECMR in region B was closely related to population density (r = −0.524, p < 0.01) and gross domestic product density (r = −0.511, p < 0.01) when the ageing degree was controlled, while these associations were weak in region C. The epidemiological characteristics of EC in Guangzhou city were spatially featured and potentially associated with socioeconomic conditions, medical resources and ageing degree on a fine scale across Guangzhou city. This study could provide scientific basis for local authorities to implement more targeted EC interventions. Full article

(This article belongs to the Special Issue Cancer Health Disparities)

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10 pages, 2018 KiB

Open AccessArticle

Correlations between Mortality-to-Incidence Ratios and Health Care Disparities in Testicular Cancer

by Wen-Jung Chen, Cheng-Yu Huang, Yu-Hui Huang, Shao-Chuan Wang, Tzuo-Yi Hsieh, Sung-Lang Chen, Wen-Wei Sung and Tsung-Hsien Lee

Int. J. Environ. Res. Public Health 2020, 17(1), 130; https://doi.org/10.3390/ijerph17010130 - 23 Dec 2019

Cited by 8 | Viewed by 2672

Abstract

The mortality-to-incidence ratio (MIR) is associated with the clinical outcomes of different types of cancer as well as the ranking of health care systems. However, the association between MIRs for testicular cancer and health care disparities, including differences in expenditures and health system rankings, has not yet been reported. We used the Spearman’s rank correlation coefficient (CC) to analyze the correlation between testicular cancer MIRs and both total expenditures on health/gross domestic product (e/GDP) and the World Health Organization’s (WHO) health system rankings. After screening the data for quality and missing information, 57 countries were chosen for analysis. Generally, developed countries and regions had relatively high rates of incidence/mortality, but with a favorable MIR. Among the continents, Europe had the highest incidence rates, whereas the highest MIRs were in Africa. Globally, favorable testicular cancer MIRs were observed in countries with both a high e/GDP and a good WHO ranking (R² = 0.325, p < 0.001 and CC = −0.568, p < 0.001; R² = 0.367, p < 0.001 and CC = 0.655, p < 0.001, respectively). In conclusion, the MIR for testicular cancer varies in countries and regions based on both their total health expenditure and their health care system ranking. Full article

(This article belongs to the Special Issue Cancer Health Disparities)

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16 pages, 959 KiB

Open AccessArticle

Understanding Differences in Cancer Survival between Populations: A New Approach and Application to Breast Cancer Survival Differentials between Danish Regions

by Marie-Pier Bergeron-Boucher, Jim Oeppen, Niels Vilstrup Holm, Hanne Melgaard Nielsen, Rune Lindahl-Jacobsen and Maarten Jan Wensink

Int. J. Environ. Res. Public Health 2019, 16(17), 3093; https://doi.org/10.3390/ijerph16173093 - 26 Aug 2019

Cited by 5 | Viewed by 2901

Abstract

Large variations in cancer survival have been recorded between populations, e.g., between countries or between regions in a country. To understand the determinants of cancer survival differentials between populations, researchers have often applied regression analysis. We here propose the use of a non-parametric decomposition method to quantify the exact contribution of specific components to the absolute difference in cancer survival between two populations. Survival differences are here decomposed into the contributions of differences in stage at diagnosis, population age structure, and stage-and-age-specific survival. We demonstrate the method with the example of differences in one-year and five-year breast cancer survival between Denmark’s five regions. Differences in stage at diagnosis explained 45% and 27%, respectively, of the one- and five-year survival differences between Zealand and Central Denmark for patients diagnosed between 2008 and 2010. We find that the introduced decomposition method provides a powerful complementary analysis and has several advantages compared with regression models: No structural or distributional assumptions are required; aggregated data can be used; and the use of absolute differences allows quantification of the survival that could be gained by improving, for example, stage at diagnosis relative to a reference population, thus feeding directly into health policy evaluation. Full article

(This article belongs to the Special Issue Cancer Health Disparities)

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9 pages, 1392 KiB

Open AccessArticle

The Association between Mortality-to-Incidence Ratios and Health Expenditures in Brain and Nervous System Cancers

by Tsung-Han Lee, Wen-Wei Sung, Lung Chan, Hsiang-Lin Lee, Sung-Lang Chen, Yu-Hui Huang and Aij-Lie Kwan

Int. J. Environ. Res. Public Health 2019, 16(15), 2739; https://doi.org/10.3390/ijerph16152739 - 31 Jul 2019

Cited by 1 | Viewed by 2358

Abstract

Mortality-to-incidence ratios (MIRs) are alternative parameters used to evaluate the prognosis of a disease. In addition, MIRs are associated with the ranking of health care systems and expenditures for certain types of cancer. However, a lack of association between MIRs and pancreatic cancer has been noted. Given the poor prognosis of brain and nervous system cancers, similar to pancreatic cancer, the relation of MIRs and health care disparities is worth investigating. We used the Spearman’s rank correlation coefficient (CC) to analyze the correlation between the MIRs in brain and nervous system cancers and inter-country disparities, including expenditures on health and human development index. Interestingly, the MIRs in brain and nervous system cancers are associated with the human development index score (N = 157, CC = −0.394, p < 0.001), current health expenditure (CHE) per capita (N = 157, CC = −0.438, p < 0.001), and CHE as percentage of gross domestic product (N = 157, CC = −0.245, p = 0.002). In conclusion, the MIRs in the brain and nervous system cancer are significantly associated with health expenditures and human development index. However, their role as an indicator of health disparity warrants further investigation. Full article

(This article belongs to the Special Issue Cancer Health Disparities)

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Other

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8 pages, 284 KiB

Open AccessConcept Paper

Reconceptualising Rural Cancer Inequalities: Time for a New Research Agenda

by Christina Dobson, Greg Rubin, Peter Murchie, Sara Macdonald and Linda Sharp

Int. J. Environ. Res. Public Health 2020, 17(4), 1455; https://doi.org/10.3390/ijerph17041455 - 24 Feb 2020

Cited by 9 | Viewed by 2942

Abstract

Evidence has shown for over 20 years that patients residing in rural areas face poorer outcomes for cancer. The inequalities in survival that rural cancer patients face are observed throughout the developed world, yet this issue remains under-examined and unexplained. There is evidence to suggest that rural patients are more likely to be diagnosed as a result of an emergency presentation and that rural patients may take longer to seek help for symptoms. However, research to date has been predominantly epidemiological, providing us with an understanding of what is occurring in these populations, yet failing to explain why. In this paper we outline the problems inherent in current research approaches to rural cancer inequalities, namely how ‘cancer symptoms’ are conceived of and examined, and the propensity towards a reductionist approach to rural environments and populations, which fails to account for their heterogeneity. We advocate for a revised rural cancer inequalities research agenda, built upon in-depth, community-based examinations of rural patients’ experiences across the cancer pathway, which takes into account both the micro and macro factors which exert influence on these experiences, in order to develop meaningful interventions to improve cancer outcomes for rural populations. Full article

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