Fundamental causes of disease and cancer treatment: Examining the life-course of cancer inequality due to the introduction of treatments for Hodgkin's lymphoma

Contemporary studies in disparities of cancer mortality have noted an association between persistent negative health outcomes and social conditions. Fundamental cause theory posits that social and economic inequalities persist because individuals with more social and economic resources are better able to avoid health risks and to attenuate the consequences of disease. The history of Hodgkin's lymphoma, for which a cure was first found in 1968 with large-scale testing completed in 1970, presents a unique opportunity to follow the impact of the fundamental causes of disease over time for a cancer where survival outcomes in the US have recently aligned across race and gender. Internationally, recovery rates vary strongly by socioeconomic status. Currently in the US, 5-year survival rates are: 84.0% for white men; 86.7% for white women; 78.5% for black men; and 87.1% for black women (1996–2002 rates). It is expected that, historically, these outcomes were more disparate. Using death certificate data compiled by the National Center for Health Statistics from 1968 through 2005, combined with information from the United States Census Bureau, this study will examine the life-course of cancer inequality due to first the introduction of, and then further refinements to, treatments in Hodgkin's lymphoma. The discussion considers the impact of differential decreases in Hodgkin's mortality, after the first introduction of MOPP combination chemotherapy. Since treatment standards continue to be refined, examination of the life-course of cancer inequality has the potential to provide insight into inequalities that could arise and provide direction for policy targeting cancer inequalities.