{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T06:57:20Z","timestamp":1761807440188,"version":"build-2065373602"},"reference-count":24,"publisher":"BMJ","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Epidemiol Community Health"],"published-print":{"date-parts":[[1992,8]]},"abstract":"<jats:p>STUDY OBJECTIVE--The aim was to examine the epidemiology of unknown primary cancer mortality in the USA during 1979 to 1988 by age, sex, race, year, and geographical area. DESIGN--National (US) and state data were abstracted for deaths due to ill defined cancer (ICD-9 195.0 to 199.1) and all cancers combined (ICD-9 140.0-209.9). Age adjusted mortality rates were calculated using the 1980 USA population as the standard, and standardised rate ratios were derived. National total cancer incidence data were obtained from the surveillance, epidemiology and end results (SEER) program, and age and sex specific relative (black\/white) cancer incidence rates were derived and compared to relative (black\/white) mortality rates for ill defined cancer. State and regional median family income levels were obtained from the 1980 census and compared to corresponding mortality rates. SETTING--This study used data for the US population, the 50 states, and the District of Columbia. MEASUREMENTS AND MAIN RESULTS--During 1984-1988, ill defined cancers accounted for an average of 34,921 deaths each year in the USA (13.7 per 100,000 population). The mortality rate due to ill defined cancers is greater among blacks (19.3 per 100,000) than whites (13.2 per 100,000) (RR = 1.5) and has not declined since 1979. There is considerable geographical variation in the ill defined cancer mortality rate. Thus among blacks the highest rates were clustered in the central states (23 per 100,000) and the lowest rates were seen in the mountain and western states (17 per 100,000). The District of Columbia had the highest overall rate (21.7 per 100,000) when compared to all other states. The black\/white relative mortality rate due to ill defined cancer was consistently greater than the black\/white relative incidence of all cancers. CONCLUSIONS--Ill defined cancer mortality is the fourth leading site of cancer mortality in the USA, and accounts for 7.4% of cancer deaths annually. The large proportion of ill defined cancer deaths may have biased the accuracy of national and local cancer incidence and mortality statistics. The higher mortality of ill defined cancer among blacks is not explained by the higher overall cancer incidence among blacks and suggests the influence of socioeconomic or cultural barriers that may result in underutilisation of health services or substandard health care. Ill defined cancer mortality may be a sentinel indicator of deficiencies in the health care delivery system as well as a measure of progress against cancer.<\/jats:p>","DOI":"10.1136\/jech.46.4.390","type":"journal-article","created":{"date-parts":[[2008,11,12]],"date-time":"2008-11-12T15:10:54Z","timestamp":1226502654000},"page":"390-393","source":"Crossref","is-referenced-by-count":6,"title":["Racial differences in ill defined cancer mortality in the United States and in the District of Columbia."],"prefix":"10.1136","volume":"46","author":[{"given":"E","family":"Schwartz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V Y","family":"Kofie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S R","family":"Sturgeon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1992,8,1]]},"reference":[{"key":"ref_1","article-title":"International classification of diseases, 9th revision","author":"Organization, World Health","year":"1977","unstructured":"World Health Organization. International classification of diseases, 9th revision. Geneva: WHO, 1977."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0147-0272(79)80019-7","article-title":"Metastases of undetermined source","volume":"4","author":"Krementz, E.T.; Cerise, E.J.; Foster, D.S.; Morgan, L.R.","year":"1979","unstructured":"Krementz ET, Cerise EJ, Foster DS, Morgan LR. Metastases of undetermined source. Curr Probl Cancer 1979; 4: 1-37.","journal-title":"Curr Probl Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1093\/oxfordjournals.aje.a115550","article-title":"Symptoms, signs and ill-defined conditions: a leading cause of death among minorities","volume":"131","author":"Becker, T.M.; Wiggins, C.L.; Key, C.R.; Samet, J.M.","year":"1990","unstructured":"Becker TM, Wiggins CL, Key CR, Samet JM. Symptoms, signs and ill-defined conditions: a leading cause of death among minorities. Am J Epidemiol 1990; 131: 664-8.","journal-title":"Am J Epidemiol"},{"article-title":"US Dept of Commerce. Census of the population. General social and economic characteristics-1980","year":"1983","key":"ref_4","unstructured":"US Dept of Commerce. Census of the population. General social and economic characteristics-1980. Washington DC: Bureau of the Census, 1983."},{"key":"ref_5","first-page":"950","article-title":"US cancer mortality rates and","volume":"1","author":"Riggan, W.B.; Van Bruggen, J.; Acquavella, J.F.; Beaubier, J.; Mason, T.J.","year":"1983","unstructured":"Riggan WB, Van Bruggen J, Acquavella JF, Beaubier J, Mason TJ. US cancer mortality rates and trends, 1 950-1979. Washington DC: NCI\/EPA, 1983.","journal-title":"trends"},{"key":"ref_6","article-title":"Provisional population estimates","author":"of the District of Columbia, Government","year":"1986","unstructured":"Government of the District of Columbia. 1986 Provisional population estimates. Washington DC: Office of Planning, Data Services Division, 1987."},{"article-title":"Public access mortality tape, 1969-1988","author":"National Center for Health Statistics","key":"ref_7","unstructured":"National Center for Health Statistics. Public access mortality tape, 1969-1988. Hyattsville, Maryland."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1093\/biomet\/46.3-4.441","article-title":"Confidence intervals for the expectation of a Poisson variable","volume":"46","author":"Crow, E.L.; Gardner, R.S.","year":"1959","unstructured":"Crow EL, Gardner RS. Confidence intervals for the expectation of a Poisson variable. Biometrika 1959; 46: 441-7.","journal-title":"Biometrika"},{"key":"ref_9","article-title":"Cancer control objectives for the nation","author":"National Cancer Institute","year":"1985","unstructured":"National Cancer Institute. Cancer control objectives for the nation: 1985-2000."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1056\/NEJM198605083141905","article-title":"Progress against cancer?","volume":"314","author":"Bailer, J.C.; Smith, E.M.","year":"1986","unstructured":"Bailer JC, Smith EM. Progress against cancer? NEnglj Med 1986; 314: 1226-32.","journal-title":"NEnglj Med"},{"key":"ref_11","article-title":"Cancer statistics review","volume-title":"Division of Cancer Prevention and Control, Surveillance Program","author":"National Cancer Institute","year":"1973","unstructured":"National Cancer Institute. Cancer statistics review, 19731987. Bethesda, Maryland: Division of Cancer Prevention and Control, Surveillance Program, 1991."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"133","DOI":"10.2105\/AJPH.72.2.133","article-title":"On the distribution of underlying causes of death","volume":"72","author":"Gittelsohn, A.M.","year":"1982","unstructured":"Gittelsohn AM. On the distribution of underlying causes of death. Am J Public Health 1982; 72: 133-40.","journal-title":"Am J Public Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"242","DOI":"10.2105\/AJPH.71.3.242","article-title":"Accuracy of cancer death certificates and its effect on cancer mortality statistics","volume":"71","author":"Percy, C.; Stanek, E.; Gloeckler, L.","year":"1981","unstructured":"Percy C, Stanek E, Gloeckler L. Accuracy of cancer death certificates and its effect on cancer mortality statistics. AmJ Public Health 1981; 71: 242-50.","journal-title":"AmJ Public Health"},{"article-title":"Robert Wood Johnson Foundation. Access to health care in the United States: results of a 1986 survey","year":"1987","key":"ref_14","unstructured":"Robert Wood Johnson Foundation. Access to health care in the United States: results of a 1986 survey. Princeton, NJ: Special report No 2, 1987."},{"key":"ref_15","first-page":"91","article-title":"US General Accounting Office. Health insurance coverage: A profile of the uninsured in selected states","year":"1991","unstructured":"US General Accounting Office. Health insurance coverage: A profile of the uninsured in selected states. Gaithersburg, Maryland: GAO\/HRD-91-31FS, 1991."},{"key":"ref_16","first-page":"275","article-title":"Ambulatory medical care among adult black Americans: the hospital emergency room","volume":"78","author":"Neighbors, H.W.","year":"1986","unstructured":"Neighbors HW. Ambulatory medical care among adult black Americans: the hospital emergency room. JNatl Med Assoc 1986; 78: 275-82.","journal-title":"JNatl Med Assoc"},{"article-title":"US Dept of Health and Human Services. Health ofblack and white Americans, 1985-1987. National Center for Health Statistics, Series 10: data from the health interview survey, No 171","year":"1990","key":"ref_17","unstructured":"US Dept of Health and Human Services. Health ofblack and white Americans, 1985-1987. National Center for Health Statistics, Series 10: data from the health interview survey, No 171. Hyattsville, Maryland, 1990."},{"key":"ref_18","article-title":"Cancer knowledge, attitudes, and practices among black Americans","volume-title":"among black populations","author":"Denniston, R.W.","year":"1981","unstructured":"Denniston RW. Cancer knowledge, attitudes, and practices among black Americans. In Mettlin C, ed. Cancer among black populations. New York: Alan R Liss, 1981."},{"key":"ref_19","article-title":"Technical report-Cancer prevention awareness survey (Wave II)","author":"National Cancer Institute","year":"1986","unstructured":"National Cancer Institute. Technical report-Cancer prevention awareness survey (Wave II). Bethesda, MD: NIH No 87-2907, 1986."},{"key":"ref_20","first-page":"263","article-title":"Cancer and the socioeconomically disadvantaged","volume":"39","author":"Freeman, H.P.","year":"1990","unstructured":"Freeman HP. Cancer and the socioeconomically disadvantaged. CA 1990; 39: 263-95.","journal-title":"CA"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1056\/NEJM196803072781006","article-title":"Low income and barriers to use of health services","volume":"278","author":"Bergner, L.; Yerby, A.","year":"1968","unstructured":"Bergner L, Yerby A. Low income and barriers to use of health services. N Engl J Med 1968; 278: 541-6.","journal-title":"N Engl J Med"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1093\/ije\/19.3.591","article-title":"Black\/white comparisons ofdeaths preventable by medical intervention: United States and the District of Columbia 1980-1986","volume":"19","author":"Schwartz, E.; Kofie, V.Y.; Rivo, M.; Tuckson, R.V.","year":"1990","unstructured":"Schwartz E, Kofie VY, Rivo M, Tuckson RV. Black\/white comparisons ofdeaths preventable by medical intervention: United States and the District of Columbia 1980-1986. Int J Epidemiol 1990; 19: 591-8.","journal-title":"Int J Epidemiol"},{"article-title":"US Dept of Human Services. US decennial life tables for 1979-1981. Vol 2. State life tables, number 9","year":"1986","key":"ref_23","unstructured":"US Dept of Human Services. US decennial life tables for 1979-1981. Vol 2. State life tables, number 9. Hyattsville: National Center for Health Statistics, 1986."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1056\/NEJM197603112941104","article-title":"Measuring the quality of medical care-a clinical method","volume":"294","author":"Rutstein, D.D.; Berenberg, W.; Chalmers, T.C.; Child, C.G.; Fishman, A.P.; Perrin, E.B.","year":"1976","unstructured":"Rutstein DD, Berenberg W, Chalmers TC, Child CG, Fishman AP, Perrin EB. Measuring the quality of medical care-a clinical method. N Engl J Med 1976; 294: 582-8.","journal-title":"N Engl J Med"}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech.46.4.390","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T12:22:23Z","timestamp":1759494143000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech.46.4.390"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1992,8]]},"references-count":24,"journal-issue":{"issue":"4","published-online":{"date-parts":[[1992,8,1]]},"published-print":{"date-parts":[[1992,8]]}},"alternative-id":["10.1136\/jech.46.4.390"],"URL":"https:\/\/doi.org\/10.1136\/jech.46.4.390","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"type":"print","value":"0143-005X"},{"type":"electronic","value":"1470-2738"}],"subject":[],"published":{"date-parts":[[1992,8]]}}}