title: Rural-urban differences in colon cancer risk in blacks and whites: the North Carolina Colon Cancer Study.
abstract: BACKGROUND
  Geographic and racial variations in cancer incidence have been observed. Studies of colorectal carcinoma indicate a higher incidence and mortality rate for blacks than for whites in the United States.
  
  
  OBJECTIVE
  We evaluated the effect of rural versus urban residence on colon cancer risk and stage of disease at diagnosis in blacks and whites.
  
  
  METHODS
  Interviews were conducted with 558 colon cancer cases and 952 controls enrolled in the North Carolina Colon Cancer Study, a population-based case-control study of blacks and whites residing in 33 contiguous counties.
  
  
  RESULTS
  Residence in a rural area was associated with increased colon cancer risk (odds ratio, 1.4; 95% confidence interval, 1.1-1.8). This association was no longer significant after controlling for recent use of colorectal cancer screening tests (odds ratio, 1.2; 95% confidence interval, 0.9-1.6). Risk estimates were not modified by race nor were they markedly different for extent of disease at diagnosis. However, colorectal cancer screening rates were lower for blacks than for whites.
  
  
  CONCLUSIONS
  Our findings suggest that rural blacks and whites are at increased risk of colon cancer regardless of stage of disease at diagnosis than their urban counterparts; this relationship may be mediated by screening behavior.
authors.affiliation: Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah 84112, USA. anita.kinney@hci.utah.edu
authors.forename: Anita Yeomans
authors.initials: AY
authors.lastname: Kinney
authors.forename: Janna
authors.initials: J
authors.lastname: Harrell
authors.forename: Marty
authors.initials: M
authors.lastname: Slattery
authors.forename: Christopher
authors.initials: C
authors.lastname: Martin
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sandler
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D018570:Risk Assessment; D012424:Rural Population; D014505:Urban Population; D044465:White People