Map of the United States highlighting cancer disparities.

Income and Cancer: Unmasking the County-Level Divide

Mira Elwood in Health & Wellness December 2025 • 4 min read.

"New study reveals how income disparities impact cancer death rates across US counties, highlighting key factors that could bridge the gap."

In the United States, cancer remains a formidable health challenge, and while advancements in prevention, diagnosis, and treatment have significantly reduced mortality rates, these benefits are not shared equally. Stark disparities persist, with cancer death rates varying considerably across different regions and socioeconomic groups. This raises critical questions about the underlying factors that drive these inequalities and how they can be addressed.

A recent study published in JAMA Network Open sheds light on the intricate relationship between county-level income and cancer death rates in the US. Researchers sought to determine whether income disparities contribute to the wide variations in cancer mortality observed across US counties, and to identify the specific factors that might mediate this association.

By analyzing data from over 3,000 counties, the study reveals a clear link between income levels and cancer death rates. However, the most compelling aspect of the research lies in its exploration of the factors that explain this disparity, offering valuable insights for targeted interventions and policy changes.

The Income-Cancer Connection: Unpacking the Disparities

Map of the United States highlighting cancer disparities.

The research team, led by Jeremy M. O'Connor and Cary P. Gross, conducted a cross-sectional study using death records from the National Center for Health Statistics in 2014. They analyzed data from all US counties and county equivalents, categorizing them into low-, medium-, and high-income groups based on median household income (MHI).

The study revealed a significant disparity in cancer death rates across the income groups. Low-income counties had substantially higher cancer death rates compared to their wealthier counterparts:

High-income counties: 185.9 deaths per 100,000 person-years
Medium-income counties: 204.9 deaths per 100,000 person-years
Low-income counties: 229.7 deaths per 100,000 person-years

But the study didn't stop at identifying the disparity. The researchers delved deeper to uncover the factors mediating the income-cancer relationship. Through mediation models, they pinpointed several key variables that explained a significant portion of the income-related disparity.

Closing the Gap: Towards Equitable Cancer Outcomes

This study paints a clear picture: income inequality significantly impacts cancer death rates across US counties. But it also provides a roadmap for action. By identifying the key mediators – food insecurity, low-quality care, smoking, and physical inactivity – policymakers and public health officials can develop targeted interventions to address these specific challenges in low-income communities.

Future research should focus on evaluating the effectiveness of interventions aimed at these mediators. Do programs that improve access to healthy food, enhance the quality of clinical care, or reduce smoking rates lead to a measurable reduction in cancer death rates in low-income counties? Answering these questions is crucial for developing evidence-based strategies to close the cancer disparity gap.

Ultimately, achieving equitable cancer outcomes requires a multi-pronged approach that addresses not only individual behaviors but also the systemic factors that contribute to health disparities. By dismantling structural barriers and investing in the health and well-being of all communities, we can create a future where everyone has the opportunity to live a long and healthy life, regardless of their income or zip code.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1001/jamanetworkopen.2018.3146, Alternate LINK

Title: Factors Associated With Cancer Disparities Among Low-, Medium-, And High-Income Us Counties

Subject: General Medicine

Journal: JAMA Network Open

Publisher: American Medical Association (AMA)

Authors: Jeremy M. O’Connor, Tannaz Sedghi, Meera Dhodapkar, Michael J. Kane, Cary P. Gross

Published: 2018-10-05

Everything You Need To Know

What specific cancer death rate differences did the study find based on income levels?

The study, led by Jeremy M. O'Connor and Cary P. Gross, found a significant disparity in cancer death rates based on median household income (MHI). Low-income counties experienced notably higher rates, with 229.7 deaths per 100,000 person-years, compared to medium-income counties at 204.9 and high-income counties at 185.9 deaths per 100,000 person-years. This highlights how income inequality directly correlates with cancer mortality.

What factors were identified as the primary mediators between income and cancer death rates?

The researchers pinpointed several key variables that explain a significant portion of the income-related disparity. These mediators include food insecurity, low-quality care, smoking, and physical inactivity. Addressing these factors through targeted interventions could help reduce cancer death rates in low-income communities. These factors were found to be strongly associated with income level.

How was the study conducted, and what data was used to analyze the relationship between income and cancer death rates?

The study's methodology involved a cross-sectional analysis of over 3,000 US counties and county equivalents, using death records from the National Center for Health Statistics in 2014. Researchers categorized these counties into low-, medium-, and high-income groups based on their Median Household Income (MHI) to compare cancer death rates across different socioeconomic levels. Then, they used mediation models to identify the factors that mediated the relationship between income and cancer death rates.

Why is this study important, and what does it reveal about cancer disparities?

This study is significant because it uncovers how income disparities impact cancer death rates across US counties. By demonstrating the link between income and mortality rates, the research underscores the need for targeted interventions and policy changes aimed at addressing specific challenges in low-income communities, such as food insecurity, low-quality care, smoking, and physical inactivity. This will provide a roadmap for action to bridge the gap.

What are the potential implications of the study's findings in terms of interventions and public health strategies?

The implications of these findings are substantial, suggesting that interventions targeting food insecurity, healthcare access, smoking habits, and physical activity could significantly reduce cancer death rates in low-income areas. These interventions could include improving access to healthy foods, enhancing healthcare quality, implementing smoking cessation programs, and promoting physical activity initiatives. Addressing these factors is crucial for achieving equitable cancer outcomes across all socioeconomic groups.