Abstract

PurposeColorectal cancer mortality rates dropped by half in the past three decades, but these gains were accompanied by striking differences in colorectal cancer mortality by socioeconomic status (SES). Our research objective is to examine disparities in colorectal cancer mortality by SES, using a scientifically rigorous and reproducible approach with publicly available online tools, HD*Calc and NCI SES Quintiles.MethodsAll reported colorectal cancer deaths in the United States from 1980 to 2010 were categorized into NCI SES quintiles and assessed at the county level. Joinpoint was used to test for significant changes in trends. Absolute and relative concentration indices (CI) were computed with HD*Calc to graph change in disparity over time.ResultsDisparities by SES significantly declined until 1993–1995, and then increased until 2010, due to a mortality drop in populations living in high SES areas that exceeded the mortality drop in lower SES areas. HD*Calc results were consistent for both absolute and relative concentration indices. Inequality aversion parameter weights of 2, 4, 6 and 8 were compared to explore how much colorectal cancer mortality was concentrated in the poorest quintile compared to the richest quintile. Weights larger than 4 did not increase the slope of the disparities trend.ConclusionsThere is consistent evidence for a significant crossover in colorectal cancer disparity from 1980 to 2010. Trends in disparity can be accurately and readily summarized using the HD*Calc tool. The disparity trend, combined with published information on the timing of screening and treatment uptake, is concordant with the idea that introduction of medical screening and treatment leads to lower uptake in lower compared to higher SES populations and that differential uptake yields disparity in population mortality.

Highlights

  • Colon and rectum cancer is the second most common cause of cancer death in the United States [1]

  • We evaluate disparities in colorectal cancer mortality by socioeconomic status (SES) using a set of summary indices, one relative and one absolute

  • Colorectal cancer mortality data collected by the National Vital Statistics System and accessed through the National Cancer Institute (NCI)’s SEER program and Census data for the United States from 1980 to 2010 were combined at the county level; county is the smallest unit for which mortality data are released

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Summary

Introduction

Colon and rectum cancer (hereafter colorectal cancer) is the second most common cause of cancer death in the United States [1]. Survival rates are much higher for early than for late stage disease [2]. Between 1975 and 2010, mortality rates from colorectal cancer in the United States for white males dropped from 35 to less than 20 per 100,000 population [3]. This striking drop in mortality over just three decades represents an astonishing accomplishment. We evaluate whether the reduction in colorectal cancer death rates was distributed throughout the population

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