Minority Health Social Vulnerability and Its Association with Cancer Incidence: A Nationwide Ecological Investigation.

Abstract

Background: Cancer is a major public health concern in the United States, especially among minority populations. Area-level social determinants of health (SDOH) influence cancer outcomes, but the impact of the Minority Health Social Vulnerability Index (MHSVI) on cancer incidence at the county level is less understood.Methods: We analyzed ecological data from the Agency for Health Care Research and Quality for 3,232 counties in 2019. Exposures included MHSVI themes: socioeconomic, household composition, minority status/language, housing/transportation, healthcare infrastructure/access, and medical vulnerability (continuous). Overall MHSVI was categorized into low (.01/.25), moderate (.26/.74), and high (.75/1) percentiles. The outcome was the total number of cancer cases (continuous). Covariates included US regions and rural-urban regions. Unadjusted and adjusted negative binomial regressions with population weighting were performed using STATA/MPv.17; P values ≤0.05 were considered statistically significant.Results: A total of 3,232 counties were analyzed, with an average of 2,817.9 (SD:7,733.5) cancer cases, ranging from 16 to 201,547. All variables were significantly associated with cancer cases in unadjusted analyses. Adjusted analysis showed increased cancer incidence in moderate (IRR:0.94, 95%CI:0.92-0.96, P<0.001) and high (IRR:0.86, 95%CI:0.84-0.88, P<0.001) MHSVI areas compared to low MHSVI areas. Regional differences were observed, with increased cancer incidence in the Northeast (IRR:1.18, 95%CI:1.15-1.22, P<0.001), South (IRR:1.03, 95% CI:1.01-1.05, P<0.001), and West (IRR:0.92, 95%CI:0.90-0.94, P<0.001) compared to the Midwest. Rural areas had a slight increase in cancer incidence compared to urban areas (IRR:1.03, 95%CI:1.01-1.04, P<0.001).Conclusions: Our study highlights the significant association between MHSVI and cancer incidence at the county level. Regional and rural-urban differences were evident, emphasizing the need for targeted interventions addressing SDOH to reduce cancer disparities.