Abstract
BackgroundThe state of Mississippi has the highest colorectal cancer (CRC) mortality rate in the USA. The geographic distribution of CRC screening resources and geographic- and population-based CRC characteristics in Mississippi are investigated to reveal the geographic disparity in CRC screening.MethodsThe primary practice sites of licensed gastroenterologists and the addresses of licensed medical facilities offering on-site colonoscopies were verified via telephone surveys, then these CRC screening resource data were geocoded and analyzed using Geographic Information Systems. Correlation analyses were performed to detect the strength of associations between CRC screening resources, CRC screening behavior and CRC outcome data.ResultsAge-adjusted colorectal cancer incidence rates, mortality rates, mortality-to-incidence ratios, and self-reported endoscopic screening rates from the years 2006 through 2010 were significantly different for Black and White Mississippians; Blacks fared worse than Whites in all categories throughout all nine Public Health Districts. CRC screening rates were negatively correlated with CRC incidence rates and CRC mortality rates. The availability of gastroenterologists varied tremendously throughout the state; regions with the poorest CRC outcomes tended to be underserved by gastroenterologists.ConclusionsSignificant population-based and geographic disparities in CRC screening behaviors and CRC outcomes exist in Mississippi. The effects of CRC screening resources are related to CRC screening behaviors and outcomes at a regional level, whereas at the county level, socioeconomic factors are more strongly associated with CRC outcomes. Thus, effective control of CRC in rural states with high poverty levels requires both adequate preventive CRC screening capacity and a strategy to address fundamental causes of health care disparities.
Highlights
The state of Mississippi has the highest colorectal cancer (CRC) mortality rate in the USA
Results of district‐level data Based on the prior observation [28] of substantial population-based disparities in breast cancer mortality rates, mortality-to-incidence ratios, percentages of advancedstage initial diagnoses of breast cancer, and the use of mammography, this study began by characterizing colorectal cancer attributes of Mississippi’s nine Public Health Districts (PHDs)
Results of U.S Census income data analysis The socioeconomic status (SES) attributes including mean/median household income and per capital income were examined between within and beyond 30-min drives to colonoscopy facilities and to gastroenterologists’ primary practice sites at the county level (Tables 4, 5), and only the mean per capita income had a statistically-significant difference for areas defined for both examination facilities
Summary
The state of Mississippi has the highest colorectal cancer (CRC) mortality rate in the USA. In anticipation of future global trends where colorectal cancer incidence is expected to Faruque et al BMC Res Notes (2015) 8:423 rise coincidently with increasing prevalence of obesity and tobacco smoking, this manuscript will explore a microcosm of preventive screening resource distribution effects on geographic and population-based disparities set in the context of a relatively lower-resource state in a very high-resource nation. These insights may prove useful to the design and implementation of colorectal cancer screening programs [2]. As a disease affecting a significant proportion of the working population, the cumulative lost economic productivity associated with readily-avoidable CRC deaths will amount to as much as $33.9 billion by the year 2020 [6]
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