Socioeconomic Status

Socioeconomic status (SES) remains the most widely studied variable in the area of health disparity. In many instances it is the most notable difference between Caucasians and minorities. SES is difficult to assess because income level, the most direct assessment of SES, is not routinely obtained when treating cancer patients. As a result SES is a value that must be estimated based on census tract data, patient location, or some other indirect assessment. The significance of SES as a contributing factor to health care disparity has been documented in several studies.3,6,9,10 Delay in care and decreased utility of surgical intervention are only a few of the outcomes influenced by low SES. Low SES is associated with a lack of resources. According to the US Census Bureau the official poverty rate in 2004 was 12.7%, an increase from 12.5% the year before; this percentage represents 37 million people in the United States. Forty-seven million people in the United States, 15.7%, are without health insurance.18 The economically disadvantaged are more likely to be uninsured, have less access to health care and are less likely to be informed about their risk for certain diseases.

Poverty itself is a significant impediment to obtaining health care. The 5-year survival rate for people who live in poorer census tract is more than 10% less than that for those who live in more affluent areas6 and this is shown in Figure 2. Poverty has many negative effects on health and many of these effects are worsened in chronic illnesses such as cancer. Those who are economically disadvantaged are more likely to be undereducated, more likely to have no insurance and more prone to engage in high- risk behavior. If SES is seen as the coalescence of many small barriers into a large possibly insurmountable barrier, then access to health care is the first barrier that must be addressed.

Lack of adequate health insurance is more common among the poor and this results in limited access to care which can manifest as problems in the following areas: screening, stage at diagnosis, and adequacy of treatment. With adequate access to health care patients may obtain preventative screening and diagnostic evaluation when appropriate. The relationship between race, ethnicity, SES, and preventative

Males

All races Non-Hispanic White African American American Indian/ Asian/Pacific Hispanic-Latino

African Native Islander

All races Non-Hispanic White African American American Indian/ Asian/Pacific Hispanic-Latino

African Native Islander

Females

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