Long-term all-sites cancer mortality time trends in Ohio, USA, 1970–2001: differences by race, gender and age

BACKGROUND: There were significant changes in cancer mortality in the USA over the last several decades, in the whole country and in particular states. However, no in depth analysis has been published so far, dealing with changes in mortality time trends in the state of Ohio. Since the state of Ohio belongs to the states of relatively high level of all-sites mortality in both males and females, it is of interest to analyze recent changes in mortality rates, as well as to compare them with the situation in the rest of the USA. The main aim of this study was to analyze, describe and interpret all-sites cancer mortality time trends in the population of the State of Ohio. METHODS: Cancer mortality data by age, sex, race and year for the period 1970–2001 were obtained from the Surveillance Research Program of the National Cancer Institute SEER*Stat software. A joinpoint regression methodology was used to provide estimated annual percentage changes (EAPCs) and to detect points in time where significant changes in the trends occurred. RESULTS: In both, males and females mortality rates were higher in blacks compared with whites. The difference was bigger in males (39.9%) than in women (23.3%). Mortality rates in Ohio are generally higher than average USA rates – an overall difference was 7.5% in men in 1997–2001, and 6.1% in women. All-sites mortality trends in Ohio and in the whole USA are similar. However, in general, mortality rates in Ohio remained elevated compared with the USA rates throughout the entire analyzed period. The exceptions are the rates in young and middle-aged African Americans. CONCLUSION: Although direction of time trends in Ohio are similar in Ohio and the whole US, Ohio still have cancer mortality rates higher than the US average. In addition, there is a significant discrepancy between white and black population of Ohio in all-sites mortality level, with disadvantage for Blacks. To diminish disparities in cancer mortality between African Americans and white inhabitants of Ohio efforts should be focused on increasing knowledge of black people regarding healthy lifestyle and behavioral risk factors, but also on diminishing socioeconomic differences, and last but not least, on better access to medical care

Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States.

Objective-To determine the effect of income inequality as measured by the Robin Hood index and the Gini coefficient on all cause and cause specific mortality in the United States.Design-Cross sectional ecological study.Setting-Households in the United States.Main outcome measures-Disease specific mortality, income, household size, poverty, and smoking rates for each state.Results-The Robin Hood index was positively correlated with total mortality adjusted for age (r = 0 . 54; P < 0 . 05). This association remained after adjustment for poverty (P < 0 . 007), where each percentage increase in the index was associated with an increase in the total mortality of 21 . 68 deaths per 100000. Effects of the index were also found for infant mortality (P = 0 . 013); coronary heart disease (P = 0 . 004); malignant neoplasms (P = 0 . 023); and homicide (P < 0 . 001). Strong associations were also found between the index and causes of death amenable to medical intervention. The Gini coefficient showed very little correlation with any of the causes of death.Conclusion-Variations between states in the inequality of income were associated with increased mortality from several causes. The size of the gap between the wealthy and less well off-as distinct from the absolute standard of living enjoyed by the poor-seems to matter in its own right. The findings suggest that policies that deal with the growing inequities in income distribution may have an important impact on the health of the population.Version of Recor