Despite gains in life expectancy between 1992 to 2012, large disparities in life expectancy continue to exist in the United States between subgroups of the population. This study aimed to develop detailed life tables (LT), accounting for mortality differences by race, geography, and socio-economic status (SES), to more accurately measure relative cancer survival and life expectancy patterns in the United States.
We estimated an extensive set of County SES-LT by fitting Poisson regression models to deaths and population counts for U.S. counties by age, year, gender, race, ethnicity and county-level SES index. We reported life expectancy patterns and evaluated the impact of the County SES-LT on relative survival using data from the Surveillance Epidemiology and End Results (SEER) Program cancer registries.
Between 1992 and 2012, the largest increase in life expectancy was among black men (6.8 years), however there were still large geographical differences. Life expectancy was highest for Asian or Pacific Islanders (API), and lowest for American Indians and Alaskan Natives (AIAN). In 2010, life expectancies by state ranged from 73 to 82 years for white males, 78 to 86 years for white females, 66 to 75 for black males, and 75 to 81 for black females. Comparisons of relative survival using National LT and the new County SES-LT showed that relative survival using County SES-LT improved relative survival estimates for some demographic groups, particularly in low and high SES areas, among Hispanics and AIAN, and among older male cancer patients. Relative survival using County SES-LT was 7.3% and 6.7% survival points closer to cause-specific survival compared to the National LT relative survival for AIAN and Hispanic cancer patients diagnosed between ages 75 and 84 years, respectively. Importantly, the County SES-LT relative survival estimates were higher in lower SES areas and lower in higher SES areas, reducing differences in relative survival comparisons.
The use of these new socio-economic life tables (County SES-LT) can provide more accurate estimates of relative survival, improve comparisons of relative survival among registries, better illustrate disparities and cancer control efforts, and should be used as default for cancer relative survival using U.S. data.
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The authors do not own any of the data underlying this study. The data can be accessed using the following information: 1. County level mortality (deaths) data belongs to the US Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS). The NCHS mortality data is a restricted use file because of confidentiality requirements. The mortality data for the period used in our study (1992-2012) is available in 2 Compressed Mortality File (CMF), (CMF 1989-98 Series 20 No. 2E and CMF 1999-2014 Series 20 No. 2T). Information on how to access the files are available at https://www.cdc.gov/nchs/data_access/cmf.htm#database. The data can be requested from NCHS (https://www.naphsis.org/research-requests). Access to and use of mortality from the National Center for Health Statistics (NCHS) requires the approval of a research review committee. The NCI Surveillance Research Program (SRP) has a Data User Agreement (DUA) with NCHS that permits SEER and SRP staff to use the compressed mortality files. We are not allowed to re-release the compressed mortality files. However, the DUA establishes that SRP can provide US Mortality data to SEER*Stat users in client-server mode via a secure password accessible server located at NCI. The data can be obtained at the county level and aggregated by 5 years age and 3-year calendar groupings and any cell with fewer than 10 deaths will have missing counts. The mortality rates linked to county level SES index data by 5 years age groups and 3-year period calendar years and dictionary are available at: https://seer.cancer.gov/expsurvival/yr1992thru2013.stateses/mortality.csv; https://seer.cancer.gov/expsurvival/yr1992thru2013.stateses/mortality.html 2. The results, i.e., the expected life tables data and dictionaries are available at the URL https://seer.cancer.gov/expsurvival/yr1992thru2013.stateses/expected.survival.csv, https://seer.cancer.gov/expsurvival/yr1992thru2013.stateses/expected.survival.html 3. Expected, relative survival and cause-specific survival data were used to validate the estimates. A signed SEER Research Data Agreement form is required to access the SEER incidence and survival data to protect identities of cancer patients (https://seer.cancer.gov/data/sample-dua.html). The data can be accessed through SEER*Stat software. The SEER*Stat sessions to obtain the data are included as Supporting Information files, to facilitate researchers to create the data once the data agreement is signed and they have access to the SEER*Stat software.
S1 Table. Life table model description for each state and race. https://doi.org/10.1371/journal.pone.0201034.s001 (XLSX)
Mariotto, Angela B.; Zou, Zhaohui; Johnson, Christopher J.; Scoppa, Steve; Weir, Hannah K.; and Huang, Bin, "Geographical, Racial and Socio-Economic Variation in Life Expectancy in the US and Their Impact on Cancer Relative Survival" (2018). Markey Cancer Center Faculty Publications. 120.