Abstract
Abstract Background: Low-income persons have lower colorectal cancer (CRC) survival, but little is known about area socioeconomic deprivation on CRC survival. In this study, we examined geographic variation, the role of area-level socioeconomic deprivation in CRC survival and potential mechanisms linking neighborhood socioeconomic deprivation to CRC survival using the large, geographically dispersed, population-based NIH-AARP Diet and Health study cohort. Methods: In the NIH-AARP Diet and Health study cohort, 7024 CRC cases identified in 1995–2003 were followed for their CRC-specific vital status through 2005. The Kaplan-Meier method was used to plot CRC-specific survival curve. An area-level deprivation score was developed using common factor analysis based on 21 census tract-level socioeconomic variables. Multilevel survival models were fitted to determine the extent of the small-area variation and the effect of area deprivation on survival. Six groups of individual factors, including cancer characteristics, sociodemographics, health conditions, health-related behaviors, Mediterranean dietary pattern and self-rated health, were examined to explore potential mediating pathways by which neighborhood socioeconomic deprivation exerted its influence on CRC survival. Results: There was significant geographic variation in CRC survival (variance: 0.25 – 0.30, median hazard ratio: 1.61 – 1.68, interquartile hazard ratio: 3.19 – 3.52). CRC survival was significantly lower in areas with higher socioeconomic deprivation compared to areas with the lowest socioeconomic deprivation (hazard ratio [HR] for the second least vs. least deprivation quartile: 1.23, 95% confidence interval [CI]: 1.06 – 1.43; the second most vs. least deprivation quartile: 1.23, 95% CI: 1.05 – 1.44; the most vs. least deprivation quartile: 1.23, 95% CI: 1.05 – 1.44). Individual factors investigated partially explained the effect of area socioeconomic deprivation (adjusted HR for the second least vs. least deprivation quartile: 1.20, 95% confidence interval [CI]: 1.02 – 1.41; the second most vs. least deprivation quartile: 1.14, 95% CI: 0.96 – 1.34; the most vs. least deprivation quartile: 1.08, 95% CI: 0.91 – 1.29). Conclusions: Small-area geographic variation in CRC survival was present. Interventions to improve CRC survival should target patients living in socioeconomically deprived neighborhoods. Future studies should further investigate the exact mechanisms between neighborhood deprivation and CRC survival to maximize their effect of prevention and control. Citation Information: Cancer Prev Res 2010;3(1 Suppl):B131.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
