{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T08:56:39Z","timestamp":1790758599745,"version":"4.1.0"},"reference-count":49,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Counties in persistent poverty (PP) have higher cancer\u2010related mortality rates. Intersectionality with race and rurality is present; individuals identifying as Black residing in rural PP counties have the highest cancer\u2010related mortality rates. However, heterogeneity exists throughout counties (e.g., demographics). To date, few studies evaluated the effect of small\u2010area PP residence on individual\u2010level survival and intersectionality with race and rurality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort utilized Alabama Statewide Cancer Registry data of adults with breast, prostate, colorectal, or lung cancer. The exposure was NCI\u2010designated 2010 census tract\u2010level PP (tracts with \u2265\u200920% population below poverty line for \u2265\u200930\u2009years) at diagnosis and the outcome was overall survival from date of diagnosis to death or end of follow\u2010up. Associations were estimated via sequential Cox proportional hazards models first with PP as the only predictor then adjusting for demographics (age, race, sex [colorectal, lung]), demographics plus clinical characteristics (stage, subtype [breast], and first course treatment), and finally demographics, clinical characteristics, and social determinants (rurality, insurance status). We also performed a decomposition analysis of the association between PP and survival through race and rurality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the fully adjusted model, living in a PP\u2010tract was associated with higher risk of death among those with breast (hazard ratio [95% CI]: 1.18 [1.09\u20131.27]), prostate (1.21 [1.11\u20131.31]), and lung cancer (1.09 [1.05\u20131.14]) compared to living in a non\u2010PP\u2010tract. Race and rurality were independently associated with higher risk of death across cancers. Individuals identifying as Black residing in a rural PP\u2010tract had the highest magnitude of risk for all cancers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Living in a PP\u2010tract is associated with higher risk of death among patients with breast, prostate, and lung cancer in Alabama. This association is complicated by race and rurality. Multilevel interventions tailored to local context may help overcome adverse effects of social characteristics on cancer outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.72333","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T08:04:21Z","timestamp":1790755461000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intersectionality of Race, Rurality on Persistent Poverty Disparities in Cancer Mortality in Alabama"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2952-3705","authenticated-orcid":false,"given":"Mackenzie E.","family":"Fowler","sequence":"first","affiliation":[{"name":"Department of Epidemiology School of Public Health, University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5175-5109","authenticated-orcid":false,"given":"Hayden D.","family":"Reeves","sequence":"additional","affiliation":[{"name":"Department of Health Services Administration School of Health Professions, University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7594-6587","authenticated-orcid":false,"given":"Suzanne","family":"Judd","sequence":"additional","affiliation":[{"name":"Department of Health Behavior School of Public Health, University of Alabama at Birmingham  Birmingham Alabama USA"},{"name":"Department of Biostatistics, School of Public Health University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4986-7927","authenticated-orcid":false,"given":"Kelley Pettee","family":"Gabriel","sequence":"additional","affiliation":[{"name":"Department of Epidemiology School of Public Health, University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3502-2491","authenticated-orcid":false,"given":"Geetanjali","family":"Saini","sequence":"additional","affiliation":[{"name":"Department of Nutrition Sciences School of Health Professions, University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9495-9647","authenticated-orcid":false,"given":"Mahak","family":"Bhargava","sequence":"additional","affiliation":[{"name":"Department of Nutrition Sciences School of Health Professions, University of Alabama at Birmingham  Birmingham Alabama 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