Cancer Burden in Neighborhoods with Greater Racial Diversity and Environmental Burden

Importance: Ohio has among the nation's highest environmental burden and disproportionately higher lung or bronchus cancer incidence rates. Objective: To examine (1) the association between environmental burden and cancer, (2) the association between minoritized population and cancer, and (3) the association of environmental burden-minoritized population jointly with cancer. Design, Setting, and Participants: An area-level cohort study examining mean annual age-adjusted cancer incidence rates in Ohio from 2011 to 2020. Data were analyzed between May and September 2024. Exposures: Environmental burden and racial and ethnic composition of Ohio residents from the Centers for Disease Control and Prevention's Environmental Justice Index. Main Outcomes and Measures: Age-adjusted cancer incidence rates (overall- and lung or bronchus-specific) were examined using the Ohio Cancer Incidence Surveillance System. Results: Of 2952 total census tracts in the state of Ohio, 2719 (92.1%) contained patients with any cancer and 2510 (85.0%) contained patients with lung or bronchus cancer. In the census tracts with lung or bronchus cancer, patients had a median (IQR) age of 69 (61-76) vs 65 (56-74) years overall, 1328 (52.9%) were male vs 1360 (50.1%) overall, and the median (IQR) percentage of the population that was minoritized was 11.3% (5.40%-29.0%) vs 12.0% (5.60%-32.1%) overall. For any cancer, individuals in the lowest quartile of environmental burden experienced 414.2 cases per 100000, whereas individuals in the highest quartile experienced 479.5 cases, a difference of 61.1 (95% CI, 47.89-75.42) cases per 100000 (P <.001). Similarly, in areas with the highest proportion of racially and ethnically minoritized individuals (Q4 vs Q1), overall cancer (81.27 per 100000; 95% CI, 70.08-92.45; P <.001) and lung or bronchus cancer (24.99 per 100000; 95% CI, 21.57-28.40; P <.001) significantly increased. This corresponded to a 20% (483.8 vs 402.5 cases) and 43% (82.6 vs 57.8 cases) increase in overall and lung or bronchus cancer incidence rates, respectively. Census tracts experiencing both high environmental burden and racial and ethnic diversity (Q4:Q4) had significantly higher cancer rates compared with all other regions, both overall (mean [SD], 508.5 [146.2] per 100000; 95% CI, 491.3-525.7; vs 425.4 [101.4] per 100000; 95% CI, 421.4-429.5; P <.001) and a 58.9% higher incidence of lung and bronchus cancer (mean [SD], 92.4 [41.6] per 100000; 95% CI, 87.3-97.5; vs 58.2 [20.9] per 100000; 95% CI, 55.3-61.0; P <.001). Conclusions and Relevance: This cohort study found that cancer incidence rates were associated with environmental burden and with racial and ethnic composition, suggesting the need for sustained community interventions in minoritized census regions with high environmental burden.