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RESEARCH 

Absolute and Relative Black-White 

Disparities in Cancer Incidence and 

Survival in the United States, 2009-2014 
Tomi Akinyemiju 

Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY 

40508 

Corresponding author email: tomiakin@uky.edu 

ABSTRACT 
Progress has been made in reducing the overall burden of cancer among US adults. However, racial 

differences persist across multiple cancer types. This report shows absolute and relative inequalities in 

cancer incidence and survival among Blacks and Whites in the US. Data from the Surveillance 

Epidemiology and Ends Results database between 2009-2014 were used to generate age-adjusted 

estimates of absolute and relative Black-White differences in incidence and survival rates. In 2010-2014, 

the overall cancer incidence rate ratio (IRR) comparing Blacks to Whites was 1.03 (95% CI: 1.03-1.04), 

while the incidence rate difference (IRD) was 19.3 per 100,000 (95% CI: 17.5-21.1). During this period, the 

largest relative racial disparities in incidence were observed for Kaposi Sarcoma (Black vs. White IRR: 

3.20, 95% CI: 2.80-3.40) and Melanoma of the skin (Black vs. White IRR: 0.04, 95% CI: 0.03-0.04), and in 

absolute terms it was prostate cancer (Black-White IRD per 100,000: 40, 95% CI: 39.3-40.9) and Skin 

cancer (Black-White IRD per 100,000: -35.1, 95% CI: -34.9, -35.1). In 2009-2014, the overall 5-year 

relative survival rate ratio (SRR) comparing Blacks to Whites was 0.92 (95% CI: 0.92-0.92), corresponding 

to a survival rate of 64.3% (95% CI: 64.0-64.6) among Blacks and 69.8 (95% CI: 69.7-69.9) among 

Whites. During this period, the cancer sites with the largest relative racial difference in survival were 

Mesothelioma (Black vs. White SRR: 1.82, 95% CI: 1.38-2.20) and oral cavity and pharynx (Black vs. White 

SRR: 0.54, 95% CI: 0.38-0.69). These findings indicate that racial disparities in cancer incidence and 

survival persist on the relative and absolute scale in the US. Further studies are needed to understand 

and address differential distribution of cancer-related risk factors, and improve access to high-quality 

and timely cancer treatment to enhance survival across racial groups. 

KEYWORDS: cancer incidence; cancer survival; SEER; racial disparities 

Citation: Akinyemiju  T (2019) Absolute and relative Black-White disparities in cancer incidence and survival 

in the United States, 2000-2014. Cancer Health Disparities 3:e1-e9. doi:10.9777/chd.2019.1011. 

 

 

mailto:tomiakin@uky.edu


 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e2                                              Cancer Health Disparities 

RESEARCH 

INTRODUCTION 

Cancer health disparities are defined by the National 

Cancer Institute (NCI) as adverse differences in 

cancer incidence, prevalence and mortality that exist 

among population subgroups in the United States1. 

Nearly 1.7 million new cancer cases and 596,000 

cancer deaths occurred in the US in 20162. These 

numbers reflect a 23% reduction in cancer deaths 

since the 1990s, attributable to the success of public 

health efforts focused on reducing smoking, and 

improving access to early detection and frontline 

treatment strategies2. However, these positive trends 

mask significant racial disparities in cancer incidence 

and mortality in the US1-3, a trend that emerged in 

the 1970s and has become more pronounced in 

recent years4. The issue of cancer health disparities is 

highlighted in the NCI Annual Plan, which outlines a 

focus on improving understanding of the 

multifactorial causes of cancer health disparities5. 

Disparities in cancer constitute a unique public health 

problem because the gap between population sub-

groups with the best and worse cancer outcomes 

represents theoretically avoidable diagnoses and 

deaths. Identifying the complex genetic, social 

(socio-economic status and access to healthcare), as 

well as behavioral factors associated with cancer risk 

and survival are critical to reducing the 

disproportional burden of cancer in all racial groups. 

Continuous assessment of the prevalence and 

magnitude of cancer disparities will provide valuable 

information to guide the allocation of effort and 

resources for specific cancer types, risk factors and 

racial groups to better understand and ultimately 

eliminate existing disparities. Using data from the 

population-based Surveillance Epidemiology and 

Ends Results (SEER), Black and White absolute and 

relative disparities in cancer incidence and survival by 

cancer site in the US in 2009-2014 are presented. 

METHODS 

Data from the National Cancer Institute SEER 

database (November 2016) submission was utilized 

for this analysis6. SEER is a population-based 

database that covers approximately 30% of the US 

population, and includes detailed clinical 

information on all incident cancer cases diagnosed 

in the following states/regions: Atlanta, Georgia; 

Connecticut; Detroit, Michigan; Hawaii; Iowa; New 

Mexico; San-Francisco-Oakland, California; Seattle, 

Washington; Utah; Los Angeles, California; San 

Jose-Monterey, California; rural Georgia; Greater 

California; Kentucky; Louisiana; Greater Georgia; 

and New Jersey. Age-adjusted incidence (2010-

2014) and 5-year relative survival (2009-2014) rates 

for each first primary cancer site by race (Black and 

Whites) among individuals ages 20 years and older 

were obtained from SEER*Stat. 

Incidence and survival rates and 95% confidence 

intervals were calculated in SEER*Stat, age-

adjusted to the 2000 US standard million 

population for each time period evaluated. 

Absolute measures of inequality in both incidence 

and survival were calculated as the difference of 

Black-to-White incidence and survival rates, while 

relative measures of inequality were calculated as 

the ratio of Black-to-White incidence and survival 

rates. This approach of reporting both absolute 

and relative racial differences in measures of 

health outcomes has been recommended by the 

National Cancer Institute for evaluating the burden 

and progress towards eliminating health 

disparities7. 

RESULTS 

Between 2010 and 2014, the overall IRR comparing 

Blacks to Whites was 1.03 (1.03-1.04), 

corresponding to an age-adjusted incidence rate 



 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e3                                              Cancer Health Disparities 

RESEARCH 

of 610.6 per 100,000 among Blacks and 591.3 per 

100,000 among Whites. Kaposi Sarcoma (IRR: 3.20, 

95% CI: 2.80-3.40) and Melanoma of the skin (IRR: 

0.04, 95% CI: 0.03-0.04) were sites with the largest 

relative incidence disparity (Fig 1). Blacks had 

higher IRR compared with Whites in 39 out of 101 

cancer sites, while Whites had higher IRR than 

Blacks in 43 out of 101 cancer sites. In absolute 

terms, the overall incidence rate difference 

between Blacks and Whites was 19.3 per 100,000 

(17.5-21.1), with prostate (40.1, 95% CI: 39.3-40.9) 

and skin cancer (-35.1, 95% CI: -34.9, -35.1) having 

the largest absolute incidence rate difference (Fig 

2). Between 2009 and 2014, the overall SRR 

comparing Blacks to Whites was 0.92 (95% CI: 

0.92-0.92), ranging from 0.54 (95% CI: 0.38-0.69) 

for Other oral cavity and pharynx to 1.82 (95% CI: 

1.38-2.20) for Mesothelioma (Fig 3). Blacks had 

lower relative 5-year survival compared with 

Whites in 76 out of 99 cancer sites, while Whites 

had lower relative 5-year survival compared with 

Blacks in 20 out of 99 cancer sites. In absolute 

terms, there was a 5.5% (95% CI: -5.7, -5.3) lower 

survival among Blacks compared with Whites 

overall, ranging from -26.1% (95% CI: -31.9, -19.3) 

for Other oral cavity to 8.7% (95% CI: 5.6-11.1) for 

Other Endocrine including thymus (Fig 4). In 2010-

2014, the cancer sites with at least a 2-fold greater 

incidence among Blacks compared with Whites 

were Kaposi Sarcoma, Myeloma and Uterus, and 

those with greater incidence among Whites 

compared with Blacks (> 5-fold) were Melanoma 

of the skin, Skin cancer, Lip cancer, Eye and Orbit, 

Testis and Ureter. 



 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e4                                              Cancer Health Disparities 

RESEARCH 

Figure 1: Black vs. White Incidence Rate Ratios and 95% CI, SEER 2010-2014 

 



 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e5                                              Cancer Health Disparities 

RESEARCH 

Figure 2: Black vs. White Incidence Rate Difference and 95% CI, SEER 2010-2014 

 



 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e6                                              Cancer Health Disparities 

RESEARCH 

Figure 3: Black vs. White Survival Rate Ratios and 95% CI, SEER 2009-2014 

 



 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e7                                              Cancer Health Disparities 

RESEARCH 

Figure 4: Black vs. White Survival Rate Difference and 95% CI, SEER 2009-2014 

 



 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e8                                              Cancer Health Disparities 

RESEARCH 

DISCUSSION 

Cancer remains a leading cause of morbidity and 

mortality among US adults, and while progress has 

been made on the ‘war against cancer’, significant 

gaps remain in incidence and mortality by race. 

This persistent disparity in the US often constitutes 

a public health failure, signifying inequitable access 

to primary (risk reduction), secondary (screening 

and early detection) and tertiary (timely, high-

quality treatment) prevention strategies, or may 

reflect underlying differences in etiology of specific 

cancers e.g. higher risk of skin cancer observed 

among Whites compared with Blacks. While the 

fundamental causes of cancer disparities are 

multifactorial and complex, they include aspects of 

genetic, epigenetic, molecular, behavioral and 

social factors. Racial differences in cancer 

outcomes may operate through differential access 

to cancer prevention strategies, prevalence of 

mediating risk factors such as sun exposure, 

obesity and diabetes, and/or distribution of 

chronic inflammation, metabolic and/or immune-

related biological changes that play a key role in 

tumorigenesis and prognosis. Critically, the 

interplay between race, social and biological 

factors in predicting cancer risk and outcomes 

remains poorly understood. Targeted strategies to 

reduce incidence of specific cancers are critical, 

which requires better understanding of racial 

differences in risk and prognostic factors e.g. HIV 

and HPV infection linked with Kaposi Sarcoma and 

Oral/Cervical cancers, and exposures to 

environmental carcinogens linked with 

Mesothelioma. Research studies characterizing 

how multiple risk factors interact to differentially 

impact cancer outcomes by race, and identifying 

effective and targeted prevention and treatment 

strategies remain scarce and inadequate for the 

magnitude of the problem. Precision therapies and 

genomics targeting specific pathways in cancer are 

heralded as the next frontier in cancer care; 

however, population-based approaches to reduce 

racial differences in cancer risk and survival, and 

inclusion of racially diverse populations in precision 

medicine trials, are critical to ensure equitable 

access to these benefits. 

Author Affiliations 
Department of Epidemiology, University of Kentucky 

College of Public Health; Markey Cancer Center 

Author contribution 
Dr. Akinyemiju had full access to the data in the 

study and takes responsibility for the integrity of the 

data and accuracy of the data analysis 

Funding/Support 
Dr. Akinyemiju was supported by grant K01TW010271 

from the National Institutes of Health 

Role of the Funder/Sponsor 
The National Institute of Health had no role in the 

design and conduct of the study. The content is 

solely the responsibility of the authors and does not 

necessarily represent the official views of the funding 

agencies. 

Acknowledgement 
The author thanks Arnisha Atkinson and Nimish Valvi 

for their help in preparing the data tables, and Dr. 

Stella Aslibekyan for comments on an earlier draft. 

Conflict of interest 
The authors declare that no competing or conflict of 

interests exist. The funders had no role in study 

design, writing of the manuscript, or decision to 

publish. 

 

 



 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e9                                              Cancer Health Disparities 

RESEARCH 

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