Finding 'Bright Spots': Using Multiple Measures to Examine Local-Area Racial Equity in Cancer Death Outcomes.

The purpose of this study is to present a variety of measures that quantify equity in cancer outcomes, demonstrate how the measures perform in various cancer types, and identify counties, or Bright Spots, that meet the criteria of those measures. Using county-level age adjusted death rates for 2007-2016 from the National Center for Health Statistics, we determined counties that had both equitable and optimal outcomes for the black and white death rates across five cancer types, lung/bronchus, prostate, breast, colorectal, and liver cancers. The number of counties that met the criteria ranged from 0 to 442 depending on cancer type and measure used, and prostate and male liver cancer consistently had the lowest number of Bright Spots with a maximum of 3 counties meeting the most lenient criteria. This study presents several ways to examine equity, using rate ratios and standard error measures, in cancer mortality outcomes. It highlights areas with positive progress towards equity and areas potential need for equity-focused cancer control planning. Examining local areas of positive deviance can inform cancer control programming and planning around health equity.