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Political determinants of US states' screening-amenable cancer stage at diagnosis and premature cancer mortality
Journal article   Open access   Peer reviewed

Political determinants of US states' screening-amenable cancer stage at diagnosis and premature cancer mortality

Nancy Krieger, Soroush Moallef, Tori L Cowger, Jarvis T Chen, Ruchita Balasubramanian, Alecia J McGregor, Loni Philip Tabb, William P Hanage and Mary T Bassett
JNCI cancer spectrum, v 9(5), pkaf073
01 Oct 2025
DOI: https://doi.org/10.1093/jncics/pkaf073
PMID: 40912683
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1093/jncics/pkaf073View
Published, Version of Record (VoR) Open

Abstract

Adult Breast Neoplasms - diagnosis Breast Neoplasms - mortality Breast Neoplasms - pathology Colorectal Neoplasms - diagnosis Colorectal Neoplasms - mortality Colorectal Neoplasms - pathology Early Detection of Cancer - statistics & numerical data Female Humans Male Medicaid - statistics & numerical data Medically Uninsured - statistics & numerical data Middle Aged Mortality, Premature Neoplasm Staging Neoplasms - diagnosis Neoplasms - mortality Politics Poverty - statistics & numerical data United States - epidemiology Uterine Cervical Neoplasms - diagnosis Uterine Cervical Neoplasms - mortality Uterine Cervical Neoplasms - pathology
Political determinants of cancer risk are largely unexplored, conceptually and empirically. Observational analysis of associations present in 2017-2021 between 5 state-level political metrics and 4 age-standardized cancer outcomes (regional and distant stage at diagnosis for breast, cervical, and colorectal cancer among screening-age adults and premature cancer mortality), overall and in standardized linear regression models adjusting for state-level poverty and medical uninsurance. In fully adjusted models (adjusted for state-level poverty and state-level medical uninsurance variables: % working age adults [age 35-64] without medical insurance; number of years of state Medicaid expansion), each 1 SD shift toward a more liberal political ideology (measured by voting record) among elected officials in the US House of Representatives was associated with decreased risk of diagnosis with regional and distant breast and colorectal cancer (respectively: -0.76, 95% confidence interval [CI] = -1.26 to -0.25; -0.75; 95% CI = -1.5 to 0). Risk of premature cancer mortality likewise was lower, in the fully adjusted models, with each 1 SD shift toward more liberal scores for the state electoral college vote (-2.01, 95% CI = -3.68 to -0.33), the state liberalism policy index (-2.51, 95% CI = -4.48 to -0.54), and political ideology of elected officials in the US Senate (-1.93, 95% CI = -3.71 to -0.14). Our state-level analyses suggest that political metrics are associated with preventable cancer outcomes. Efforts to reduce population burdens of cancer and inequities in these burdens could benefit from analyses of sociopolitical drivers of cancer risk across the cancer continuum.

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#5 Gender Equality
#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Oncology
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