title: Trends in the incidence of colorectal cancer in relation to county-level poverty among blacks and whites.
abstract: OBJECTIVE
  The overall incidence of colorectal cancer has been decreasing rapidly in the United States since 1998. The extent to which the recent accelerated decline varies by socioeconomic status has not been examined. We analyzed trends in colorectal cancer incidence rates from 1992-2004 by area socioeconomic status, race, gender and stage at diagnosis.
  
  
  METHODS
  Incidence data from 13 Surveillance, Epidemiology and End Results reporting areas were used to examine temporal trends in age-standardized colorectal cancer incidence rates from 1992-2004 by race, gender, stage at diagnosis and 3 levels of county poverty (counties with <10%, 10% to <20% and > or =20% of residents living below the poverty level).
  
  
  RESULTS
  Among whites, colorectal cancer incidence rates decreased in both men and women residing in low- and moderate-poverty areas. The decrease involved both early- and late-stage disease in men and late-stage disease in women. In contrast, among those residing in high-poverty areas incidence rates increased for early-stage disease in men; rates were stable for late-stage disease in men and for both categories of stage in women. Among blacks, incidence rates decreased only in men residing in low-poverty areas.
  
  
  CONCLUSIONS
  The recent decrease in colorectal cancer incidence has not yet benefited persons residing in high-poverty areas. Additional effort is needed to extend prevention and early detection measures to all segments of the population.
authors.affiliation: Department of Epidemiology and Surveillance Research, American Cancer Society, National Home Office, Atlanta, GA 30303-1002, USA. rebecca.siegel@cancer.org
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Siegel
authors.forename: Ahmedin
authors.initials: A
authors.lastname: Jemal
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thun
authors.forename: Yongping
authors.initials: Y
authors.lastname: Hao
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Ward
mesh_terms: D000328:Adult; D000367:Age Factors; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011203:Poverty; D018426:SEER Program; D012737:Sex Factors; D012923:Social Class; D014481:United States / Q000453:epidemiology