Rurality and other determinants of early colorectal cancer diagnosis in Nebraska: a 6-year cancer registry study, 1998-2003.
BACKGROUND
There are no studies of rurality, and other determinants of colorectal cancer (CRC) stage at diagnosis with population-based data from the Midwest.


METHODS
This retrospective study identified, incident CRC patients, aged 19 years and older, from 1998-2003 Nebraska Cancer Registry (NCR) data. Using federal Office of Management and Budget classifications, we grouped patients by residence in metropolitan, micropolitan nonmetropolitan, or rural nonmetropolitan counties (non-core based statistical areas). In univariate and multivariate logistic regression analyses, we examined the association of the county classification and of other determinants with early (in situ/local) versus late (regional/distant) stage at CRC diagnosis.


RESULTS
Of the 6,561 CRC patients identified, 45% were from metropolitan counties, 24% from micropolitan nonmetropolitan counties and 31% from rural nonmetropolitan counties, with 32%, 38%, and 33%, respectively, being diagnosed at an early stage. Multivariate analysis showed micropolitan nonmetropolitan residents were significantly more likely than rural nonmetropolitan residents to be diagnosed at an early stage (adjusted OR, 1.22; 95% CI: 1.05-1.42, P < .05). However, rural nonmetropolitan and metropolitan residents did not significantly differ in the likelihood of early diagnosis. Residents with Medicare rather than those with private insurance (P < .0001), married rather than unmarried residents (P < .01), and residents with rectal cancer rather than those with colon cancer (P < .0001) were more likely to be diagnosed at an early stage.


CONCLUSIONS
Early CRC diagnosis needs to be increased in rural (non-core) non-metropolitan residents, unmarried residents, and those with private insurance.
College of Pharmacy, University of Nebraska Medical Center, Omaha, NE 68198-6045, USA. jsankara@unmc.edu
Jayashri
J
Sankaranarayanan
Shinobu
S
Watanabe-Galloway
Junfeng
J
Sun
Fang
F
Qiu
Eugene
E
Boilesen
Alan G
AG
Thorson
D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D057210:Delayed Diagnosis; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009329:Nebraska / Q000453:epidemiology; D011153:Population; D012042:Registries; D012189:Retrospective Studies; D055815:Young Adult