State funding and health system factors associated with cancer mortality in older adult in the United States: 1999-2008

Background: The U.S. population is steadily growing older, while few studies have examined the influences on cancer mortality for this population, particularly as it relates to policy and funding factors. This study examines cancer mortality for older adults from the state level in the United States.

Methods: State-level data were collected from multiple sources from 1999-2008 and analyzed in regression models, including: the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (cancer mortality), the U.S. Census (2008; demographic, insurance, old-age dependency), and CDC's Behavioral Risk Factor Surveillance System (BRFSS; cancer screening, obesity, and smoking).

Results: There is a negative association between cancer prevention funding and cancer mortality in the younger age groups (50-64; all site: &beta=-0.17; prostate: &beta=-0.27; colon: &beta=-0.22; lung: &beta=-0.27; p<0.01 for all), with the exception of breast cancer. Percent African American population 65+ was strongly associated (&beta's between 0.24-0.89, p<0.05) with cancer mortality for all cancer sites, with the exception of lung cancer. Population distribution, the percent living in metro areas, was positively associated with mortality (&beta's between 0.13-0.35, p<0.05), usually for the oldest old (80+), with the exception of a negative association for prostate cancer (&beta=-0.43, p<0.01).

Conclusions: States' cancer prevention and chronic disease funding is negatively associated with cancer mortality for colon, prostate, and lung cancers and among the “young” old. Funding needs to focus on high mortality cancers and on groups where cancer disparities continue to persist with age.