National Landmark Reports Highlighting Cancer Disparities Problem

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National Landmark Reports Highlighting Cancer
Disparities Problem
1986
Pre - 1980
1996
1989
1999
2001
2002
2003
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5 Leading Causes of Death, U.S., 2003, Female
Heron, M. P., Smith, B. L. (2007). Deaths
Leading causes for 2003 (No. DHHS Publication
(PHS) 2007-1120) National Center for Health
Statistics.
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Disease always occurs within a context of human
circumstances, including economic status, social
position, culture and environment.
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Ecological Model of Health
Modified from McElroy and Townsend, 1996.
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Culture

• Environment
• Economy
• Technology
• Religion/World View
• Language
• Social Structure
• Beliefs and Values

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Poverty and gender should NOT be an offense which
is punishable by death. Harold Freeman, M.D.,
2006
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California Demographics 2000 gt36
million
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What populations have poor survival?What are
the causes of disparities in survival?How can
we eliminate disparities?
Three Major Questions
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Biases in our society due toRacismSexismAge
ism
Three Major Answers
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California Hispanic Age 35 Heart Disease Rate
CDC 6/9/05 www\\\apps.ncd.cdc.gov
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Kian and Remee Horder
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California Age 35 Heart Disease Rates by
Ethnicity v. U.S.CDC 6/9/05 www\\\apps.ncd.cdc.
gov
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http//www.cdc.gov/NCCdphp/overview.htm
Age-Adjusted Death Rates for Diseases of the
Heart Among Women, by Race/Ethnicity,19961998
Average annual deaths per 100,000 women, age
adjusted to 1940 U.S. standard population,
International Classification of Diseases, 9th
Rev., codes 390398, 402, and 404 429. Source
Journal of Womens Health and Gender-Based
Medicine, Vol. 10, No. 8, 2001. pp. 71724.
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Major Causes of Death in the U.S. Women have
higher rates than Men for CVD and Diabetes
All data are age adjusted to 2000 total U.S.
population.  McGinnis JM, Foege WH. Actual
causes of death in the United States. JAMA 1993
270220712.
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Underlying Causes of Most Chronic Diseases
35 -65 Lifestyle choices
All data are age adjusted to 2000 total U.S.
population.  McGinnis JM, Foege WH. Actual
causes of death in the United States. JAMA 1993
270220712.
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Smoking Rates Among Ethnic Populations and Gender

• Native American (40.8).
• Caucasian American (23.1).
• African American (20.8).
• Hispanic American (12.3).
• Asian/Pacific Islanders (7.1).

Among Youth 12-17 Males 19.1 Females 20.7
www.drugabusestatistics.samhsa.gov/nhsda/nhsda97/n
hsda983.htmE10E29
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Cancer Incidence TrendsCalifornia, 1988-2001
Rate per 100,000
S. Kwong, 2004
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Female Breast Cancer TrendsCalifornia, 1988-2001
S. Kwong, 2004
Rate per 100,000
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Ethnic Minorities in the U.S.

• Behavior is influenced by
• Cultural Beliefs
• Minority Status

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Relationship with Husbands of Chinese-, Japanese-
European-American Breast Cancer Survivors
Kagawa-Singer and Wellisch, 2002 Psycho-Oncology
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Relationship with Husbands of Chinese-, Japanese-
European-American Breast Cancer Survivors
Kagawa-Singer and Wellisch, 2002 Psycho-Oncology
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Comparison of Physician Discussion,
Decision-making and Disclosure at End of Life
after adjustment
Matsumura, et al. 2000
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PATH For Women
Survivors
and
THRIVERS!!
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Leading Causes of Death for Asian Males and
Females, California, 1997-2001
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Five Most Frequently Diagnosed Cancers Among
Asian/Pacific Islanders, 1997-2001
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1999-2001 Top 5 Cancer Sites
Chu, 2004
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Age-Adjusted Death Rates Due to All Causes,
California 1990
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Five Cancers contributing to overall cancer
incidence burden in males by race/ethnicity and
geography
Chinese Males
100
90
80
70
Colon (5)
60
Esophagus (6)
Stomach (7)
Rectum (5)
Percent of All Cancers
Liver (12)
50
Colon (8)
Liver (8)
40
Nasopharynx (9)
Colon (10)
Stomach (20)
30
Liver (11)
Prostate (16)
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Lung (26)
10
Lung (24)
Lung (18)
0
China
Hong Kong/
US Chinese
Singapore
Geographic Region
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Prostate CancerFive-Year Average Annual
Age-Adjusted Incidence Rates per 100,000,
California, 1997-2001
S. Kwong, 2004
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Lung and Bronchus CancerFive-Year Average Annual
Age-Adjusted Mortality Rates per 100,000,
California, 1997-2001
S. Kwong, 2004
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Chu, K. 2004
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