Abstract
BackgroundColorectal cancer (CRC) disparities vary by country and population group, but often have spatial features. This study of the United States state of Virginia assessed CRC outcomes, and identified demographic, socioeconomic and healthcare access contributors to CRC disparities.MethodsCounty- and city-level cross-sectional data for 2011–2015 CRC incidence, mortality, and mortality-incidence ratio (MIR) were analyzed for geographically determined clusters (hotspots and cold spots) and their correlates. Spatial regression examined predictors including proportion of African American (AA) residents, rural-urban status, socioeconomic (SES) index, CRC screening rate, and densities of primary care providers (PCP) and gastroenterologists. Stationarity, which assesses spatial equality, was examined with geographically weighted regression.ResultsFor incidence, one CRC hotspot and two cold spots were identified, including one large hotspot for MIR in southwest Virginia. In the spatial distribution of mortality, no clusters were found. Rurality and AA population were most associated with incidence. SES index, rurality, and PCP density were associated with spatial distribution of mortality. SES index and rurality were associated with MIR. Local coefficients indicated stronger associations of predictor variables in the southwestern region.ConclusionsRurality, low SES, and racial distribution were important predictors of CRC incidence, mortality, and MIR. Regions with concentrations of one or more factors of disparities face additional hurdles to improving CRC outcomes. A large cluster of high MIR in southwest Virginia region requires further investigation to improve early cancer detection and support survivorship. Spatial analysis can identify high-disparity populations and be used to inform targeted cancer control programming.
Highlights
Colorectal cancer (CRC) disparities vary by country and population group, but often have spatial features
Though the Thatcher et al BMC Public Health (2021) 21:1908 characteristics and risk factors of groups experiencing CRC disparities can vary by place, studying and measuring disparities is important for informing efforts to improve health equity
For mortalityincidence ratio (MIR), a high rate was concentrated in the southwest region
Summary
Colorectal cancer (CRC) disparities vary by country and population group, but often have spatial features. Thatcher et al BMC Public Health (2021) 21:1908 characteristics and risk factors of groups experiencing CRC disparities can vary by place, studying and measuring disparities is important for informing efforts to improve health equity. In the U.S, disparities in CRC incidence and mortality are associated with population characteristics, such as racial and ethnic minority status, low socioeconomic status (SES), rural residence, and lack of access to healthcare [5, 6]. Populations residing in low SES counties (geographic state subdivisions) have significantly higher CRC mortality than middle or high SES counties [5]. Rural-dwelling populations have higher CRC incidence than urban populations across most of the U.S, with mortality rates falling at a slower rate [8]. Lack of access to primary care providers (PCPs) and gastroenterologists (GIs) is associated with lower screening rates [10, 11]
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