Poverty and Cancer Disparities in Ohio.

INTRODUCTION: Poverty is associated with higher cancer rates, cancer risk factors such as tobacco use and obesity, and lack of access to cancer screening and treatment. This analysis examined differences in cancer outcomes and associated factors among the poorest counties and the most affluent counties in Ohio. METHODS: We compared cancer incidence and mortality rates and prevalence of selected cancer risk factors between the 12 poorest counties in Ohio and the 10 most affluent counties in Ohio from January 1, 2011, through December 31, 2015. We also compared stage at diagnosis of selected cancers and the health insurance and treatment status of people with cancer. RESULTS: The mortality rate for all cancers combined was 19% higher in the poorest counties (192.2 per 100,000) than in the most affluent counties (161.9 per 100,000). Cervical cancer and other smoking-related cancers had higher rates in the poorest counties, where they were more likely to be diagnosed at a late stage. The prevalence was significantly higher in Ohio's poorest counties for current tobacco smoking (25.6% vs 17.1%), obesity (32.7% vs 28.3%), and physical inactivity (29.7% vs 23.0%). Among people with cancer, a smaller percentage had private health insurance (42.9% vs 33.0%) and a greater percentage had no treatment (8.9% vs 10.4%) in the poorest counties. CONCLUSION: This study demonstrates disparities in cancer incidence, mortality, and stage, and differences in cancer risk factors, health insurance, and treatment status between Ohio's poorest and most affluent counties. This information may help to target public health interventions for the prevention, early detection, and control of cancer.

Public awareness of genetic nondiscrimination laws in four states and perceived importance of life insurance protections.

Genetic testing has grown dramatically in the past decade and is becoming an integral part of health care. Genetic nondiscrimination laws have been passed in many states, and the Genetic Information Nondiscrimination Act (GINA) was passed at the federal level in 2008. These laws generally protect individuals from discrimination by health insurers or employers based on genetic information, including test results. In 2010, Connecticut, Michigan, Ohio, and Oregon added four questions to their Behavioral Risk Factor Surveillance System (BRFSS) survey to assess interest in genetic testing, awareness of genetic nondiscrimination laws, concern about genetic discrimination in determining life insurance eligibility and cost, and perceived importance of genetic nondiscrimination laws that address life insurance. Survey results showed that awareness of genetic nondiscrimination laws was low (less than 20 % of the adult population), while perceived importance of these types of laws was high (over 80 % of respondents rated them as very or somewhat important). Over two-thirds of respondents indicated they were very or somewhat concerned about life insurance companies using genetic test results to determine life insurance coverage and costs. Results indicate a need for more public education to raise awareness of protections provided through current genetic nondiscrimination laws. The high rate of concern about life insurance discrimination indicates an additional need for continued dialogue regarding the extent of legal protections in genetic nondiscrimination laws.

Esophageal Adenocarcinoma: Opportunities for Targeted Prevention in Ohio.

OBJECTIVE: The incidence of esophageal adenocarcinoma, one of the most lethal gastroenterological diseases, has been increasing since the 1960s. Prevention of esophageal adenocarcinoma is important because no early detection screening programs have been shown to reduce mortality. Obesity, gastroesophageal reflux disease, and tobacco smoking are risk factors for esophageal adenocarcinoma. Due to the high prevalence in Ohio of obesity (32.6%) and cigarette smoking (21.0%), this study sought to identify trends and patterns of these risk factors and esophageal adenocarcinoma in Ohio as compared with the United States. METHODS: Data from the Ohio Cancer Incidence Surveillance System, Surveillance Epidemiology and End Results Program (SEER), and Behavioral Risk Factor Surveillance System were used. Incidence rates overall, by demographics and by county, as well as trends in incidence of esophageal adenocarcinoma and the percent of esophageal adenocarcinoma among esophageal cancers were examined. Trends in obesity and cigarette smoking in Ohio, and the prevalence of each by county, were reported. RESULTS: There was an increasing trend in esophageal adenocarcinoma incidence in Ohio. Ohio's average annual esophageal adenocarcinoma incidence rate was higher than the SEER rate overall and for each sex, race, and age group in 2009 to 2013. There was also an increasing prevalence of obesity in Ohio. Although the prevalence of cigarette smoking has been stable, it was high in Ohio compared with the United States. CONCLUSIONS: Health care providers and researchers should be aware of the esophageal adenocarcinoma incidence rates and risk factor patterns and tailor interventions for areas and populations at higher risk.