title: Colorectal carcinoma mortality among Appalachian men and women, 1969-1999.
abstract: BACKGROUND
  Colorectal carcinoma screening can reduce mortality, but residents of poor or medically underserved areas may face barriers to screening. The current study assessed colorectal carcinoma mortality in Appalachia, a historically underserved area, from 1969 to 1999.
  
  
  METHODS
  All counties within the 13-state Appalachian region, which stretches from southern New York to northern Mississippi, were used to calculate annual death rates for the 31-year period. Joinpoint regression analysis was used to examine trends by age and race for the Appalachian region and the remainder of the United States. Five-year rates for 1995-1999 age-adjusted to the 2000 U.S. standard population were calculated by race and age group for the Appalachian region and elsewhere in the United States.
  
  
  RESULTS
  Trend analysis showed that colorectal carcinoma death rates among both racial and gender groups studied had declined in recent years. Despite this, the rates for white males and white females were still significantly higher in Appalachia than in the rest of the country at the end of the study period, 1999. Five-year colorectal carcinoma death rates among white males (ages < 50, 50-59, and 70-79 years) and white females (ages < 50, 50-59, 70-79, > or = 80 years) were significantly higher in Appalachia than elsewhere in the United States, whereas rates among black females 60-69 and 70-79 years old were significantly lower in Appalachia.
  
  
  CONCLUSIONS
  The Appalachian region may benefit from targeted prevention efforts to eliminate disparities in the colorectal carcinoma death rates among subgroups. Further studies are needed to determine whether the higher death rates in specific Appalachian subgroups are related to a higher incidence of the disease, the cancer being at a later stage at diagnosis, poorer treatment, or other factors.
authors.affiliation: Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: Lori R
authors.initials: LR
authors.lastname: Armstrong
authors.forename: Trevor
authors.initials: T
authors.lastname: Thompson
authors.forename: H Irene
authors.initials: HI
authors.lastname: Hall
authors.forename: Steven S
authors.initials: SS
authors.lastname: Coughlin
authors.forename: Brooke
authors.initials: B
authors.lastname: Steele
authors.forename: Joe D
authors.initials: JD
authors.lastname: Rogers
mesh_terms: D001741:Black or African American; D000367:Age Factors; D000368:Aged; D001061:Appalachian Region / Q000453:epidemiology / Q000208:ethnology; D015179:Colorectal Neoplasms / Q000208:ethnology / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012737:Sex Factors; D044465:White People