Persistent Poverty

Overview

Despite advances in cancer prevention, diagnosis, treatment, and survival, disparities in cancer outcomes persist. Populations living in poverty in the U.S.—in particular those in persistent poverty —face higher rates of both cancer-specific and overall morbidity and mortality.  To shed light on this aspect of poverty, the U.S. Department of Agriculture’s Economic Research Service (ERS) has defined counties as being persistently poor if 20% or more of their populations were living in poverty based on the 1980, 1990, and 2000 decennial censuses and the 2007-11 American Community Survey 5-year estimates. Using this definition, there are 353 persistently poor counties in the U.S. (comprising 11.2% of all U.S. counties). The large majority (301, or 85.3%) of the persistent poverty counties are nonmetro, accounting for 15.2% of all nonmetro counties. Persistent poverty also demonstrates a strong regional pattern, with nearly 84% of persistent poverty counties located in the South, comprising more than 20% of all counties located in the region.

An important dimension of poverty is its persistence over time. An area that has a high level of poverty this year, but not next year, is likely better off than an area that has a high level of poverty for a longer time period. Persistent poverty areas are at an increased risk of cancer due to multiple factors, including greater carcinogen exposure, lower educational attainment, lack of adequate housing, food insecurity, and the lack of access to care. All these factors result in increased cancer incidence and delayed cancer diagnosis, treatment, and, subsequently, lower rates of survival. In particular, people living in poverty have higher rates of cancers caused by occupational, recreational, or lifestyle exposures (e.g., colorectal, laryngeal, liver, lung) and by human papillomavirus infection (e.g., anal, cervical, oral).

There are several areas where NCI can play a significant role in advancing cancer prevention and control research in persistent poverty areas. These supplements are part of a larger NCI research initiative to inform, test, and strengthen cancer control programs that are sustainable in these communities across the United States.