Rate of Cancer Diagnoses Higher Among More Affluent Communities

Overutilization of care can produce disparities between high- and low-income counties.

High-income US counties have a higher incidence of cancer compared with low-income areas.

In a study published in the New England Journal of Medicine, investigators sought to examine the association between income levels and cancer diagnosis.

Using data from the Surveillance, Epidemiology, and End Results (SEER) program, the investigators examined incidence and mortality trends for breast cancer, melanoma, prostate cancer, and thyroid cancer.

The 4 cancer types were chosen for the study because of the link between diagnosis and the intensity with which physicians seek these cancers out through screening and testing.

Year 2000 US census data was used to compare incidence and mortality of the 4 cancers in high-income versus low-income countries. The median income in wealthier counties was greater than $75,000 and less than $40,000 in low-income counties.

The results of the study showed that high-income counties had a significantly higher increase in the incidence of melanoma, breast, prostate, and thyroid cancers compared with low-income counties.

The combined death rate attributed to these 4 cancer types was similar in both groups, suggesting that the underlying burden of disease is similar in high- and low-income counties.

The cause of these disparities in cancer incidence between income levels may be due to wealthier individuals expecting and/or demanding more testing, or that health systems in these areas may view testing as a “good way to produce more patients and increase business,” the authors hypothesized.

“If we want to move toward more sustainable and affordable health care systems, we’re going to have to understand what’s driving the overutilization of care and develop better ways to address it,” said co-author Elliot Fisher, MD.

To bridge the gap, the authors suggest shifting towards alternative payment models—–such as accountable care organizations––that moves the landscape away from the traditional fee-for-service payment model.

“Doctors and other health care professionals tend to overstate the role of medical testing in promoting health—–particularly in people who aren’t sick,” said co-author Gilbert H. Welch, MD. “A healthy diet, regular exercise, and a sense of purpose are very often the best tools people, at every income level, have to maintain good health.”