Abstract A098: Intersectionality of race and rurality on disparities in cancer mortality between individuals living in persistent poverty and non-persistent poverty areas of Alabama

Abstract Introduction: Counties in persistent poverty (PP) have higher rates of cancer-related mortality. Intersectionality with both race and county-level rurality is present wherein individuals identifying as Black residing in rural, PP counties have highest age-adjusted mortality rates for most cancers. However, heterogeneity exists throughout counties (e.g. mortality rates and demographics differ within counties). Also, while mortality rates may be elevated in these counties, this does not assess individual risk of death. Therefore, this study evaluated the association between census tract-level PP and risk of mortality among adults with cancer in Alabama (AL), accounting for and examining intersectionality by race and rurality. Methods: In this population-based retrospective cohort study, we included adults (≥18 years) with incident breast, prostate, colorectal (CRC), or lung cancer diagnosed between 1/1/2010 and 12/31/2019 from the Alabama Statewide Cancer Registry. The exposure was census tract-level PP (census tracts with ≥20% population below the poverty line for ≥30 years). In AL, 19% of 1,181 census tracts are PP. The outcome was overall survival (OS) from date of diagnosis to death (any cause) or end of follow-up (12/31/2021). We performed Cox proportional hazards models to estimate associations adjusting for age, race, sex (in colorectal and lung cancer models), stage at diagnosis, census tract-level rurality (Rural-Urban Commuting Area Code) and subtype (in the breast cancer model). Results: Across all cancer types, those in living in a PP census tract were more likely to be Black and rural. Those living in a PP census tract were also more likely to die and had shorter follow-up time. Living in a PP tract was significantly associated with higher risk of death among those with breast (hazard ratio HR: 1.18, 95% confidence interval CI: 1.09–1.27), prostate (HR: 1.21, 95% CI: 1.11–1.31) and lung cancer (HR: 1.09, 95% CI: 1.05–1.14) compared to not living in a PP tract. The association between PP and OS among patients with CRC was not statistically supported (HR: 1.06, 95% CI: 0.99–1.13). Both race and rurality were independently associated with higher risk of death for all cancer types examined. For all cancer types examined, of all combinations of race, rurality and PP, individuals identifying as Black residing in a rural, PP tract had highest risk of death compared to those identifying as White residing in an urban, non-PP tract. Conclusions: Living in a PP tract is associated with higher risk of death among patients with breast, prostate, and lung cancer in AL. This association is complicated by race and rurality. These results extend prior studies examining county-level mortality rates between PP and non-PP counties. Future directions should include developing and testing multilevel interventions which are tailored to local context (e.g. smaller than the county level) to overcome adverse effects of these social characteristics on cancer outcomes. Citation Format: Mackenzie E. Fowler, Hayden D. Reeves, Suzanne Judd, Kelley Pettee. Gabriel, Geetanjali Saini, Mahak Bhargava, Timiya S. Nolan, Ritu Aneja. Intersectionality of race and rurality on disparities in cancer mortality between individuals living in persistent poverty and non-persistent poverty areas of Alabama abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A098.