Abstract
BackgroundSome have suggested gays and lesbians may carry a greater burden of colorectal cancer. To date, individual sexual orientation data are not available in cancer surveillance registries. This prevents an assessment of differences in colorectal cancer incidence and mortality by sexual orientation, using individual-level data.MethodsWe use an ecological approach to examine differences in colorectal cancer incidence and mortality by county-level sexual orientation data. From the Surveillance, Epidemiology and End Results (SEER) Program we obtain population-based surveillance data on colorectal cancer incidence and mortality from 1996 to 2004. We use Census 2000 data on same-sex partnered households, a proxy of sexual orientation, to derive county-level sexual orientation data. Using multiple regression models, we examined the county-level association of sexual minority density with colorectal cancer incidence and mortality.ResultsAfter controlling for race and SES, we identify a significant positive association between greater density of sexual minority men and women and colorectal cancer incidence. With respect to colorectal cancer mortality, we identify a positive association with density of sexual minority men, but not women.ConclusionsIn the absence of surveillance data on sexual minority individuals, ecological analyses provide estimates of associations at the aggregate level, thereby providing crucial information for follow-up studies.
Highlights
Some have suggested gays and lesbians may carry a greater burden of colorectal cancer
We propose that sexual minorities may carry a greater burden of Colorectal cancer (CRC) incidence and mortality due to their greater access barriers to the health care system
To obtain the aggregate sexual orientation data we rely on the Census Summary File 1 (SF 1), which contains information on household relationships asked of all people and housing units
Summary
Some have suggested gays and lesbians may carry a greater burden of colorectal cancer. Because sexual orientation data are not included in cancer registries, we do not know the CRC incidence and mortality in sexual minorities, defined as lesbian, gay, and bisexual individuals. There is sufficient evidence to conclude lesbians have more risk factors due to their higher rates of obesity, smoking, and heavy alcohol use [4,5,6,7,8]. Gay men’s higher level colorectal cancer risk factors are limited to their greater smoking rates compared to heterosexual men [5,6]. Gay men’s alcohol use has not been consistently identified as significantly different compared to heterosexual men [7], and gay men are significantly less likely to be overweight or obese compared to heterosexual men [10]
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