Date of Award

12-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Applied Health Research and Evaluation

Committee Chair/Advisor

Lu Zhang, PhD

Committee Member

Xuesong Han, PhD

Committee Member

Qiping Fan, DrPH

Committee Member

Rachel Mayo, PhD

Abstract

From the remnants of historical policies to modern day structural racism, health disparities in the U.S. persist in present day. Cancer continues to be the second leading cause of death in the U.S. Despite efforts to increase prevention and treatment, lower income and racial/ethnic groups are adversely impacted. Residential segregation, a byproduct of structural racism, has been employed to associate health disparities through various measures. Traditional residential segregation measures including the Dissimilarity Index, and the Isolation Index have been commonly used in literature to demonstration racial/ethnic health differences, although less explored in how they measure income differences. Emergent, innovative measures such as the Index of Concentration at the Extremes, a measure of social polarization, has been used to quantify health disparities in reference to residential segregation spanning across both race and income. Regardless of residential segregation measure, individuals in areas of increased county-level residential segregation are prone to late-stage cancer diagnosis and increased cancer mortality rates, although more consistent associations have been made with the Index of Concentration at the Extremes. Limited research has investigated these associations at smaller geographic regions, among multiple states, and across cancer types, however. Using nationwide contemporary datasets, this dissertation aims 1) to identify the most sensitive measure of residential segregation in relation to health outcomes, 2) associate the most sensitive measure with cancer diagnosis in the U.S., and 3) associate the most sensitive measure with overall cancer survival among U.S. cancer patients.

Author ORCID Identifier

0009-0003-3976-0664

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