Quantifying Cancer Equity: A Novel Index for Measurement, Planning, and Action

Abstract

Within the United States a wide variety of deep and entrenched health inequities persist. These inequities are deeply rooted and have been documented extensively in the literature with notable disparities based on race, ethnicity, income, education, gender, and geography among others. These same disparities are apparent when looking at cancer care and outcomes. While efforts to affect change in these areas are ongoing, significant work remains to improve equity while addressing the second leading cause of death in the United States. Progress is dependent on reliable measurement strategies sensitive to the unique constellation of factors influencing cancer equity. The solution is the development of a Cancer Equity Index. Consisting of four unique domains addressing the constructs of risk factors, estimates of disparity, structural factors, and access factors, the Index provides a measure that sufficiently captures the broad factors contributing to equity. Using exploratory factor analysis and structural equation modeling, we developed an Index for measuring cancer equity. Following a stringent design, testing, and revision process, the resulting Index demonstrated good performance. The Index represents a new tool to inform planning and decision making at a time where cancer inequities have garnered extensive attention. As such, the Cancer Equity Index represents a compelling step forward in the field of social epidemiology, applying a rigorous approach to better characterize the influence of equity in cancer, and outline paths toward a more equitable future.