title: Rural-urban inequalities in detection rates of colorectal tumours in the population.
abstract: BACKGROUND
  Because few data are available on this topic, we investigated the influence of geographical determinants on colorectal adenoma detection and cancer incidence rates.
  
  
  METHODS
  Between 1990 and 1999, 6220 Côte d'Or inhabitants (France) were first-diagnosed with a colorectal adenoma, and 2389 with an invasive adenocarcinoma. The impact of the rural-urban place of residence and of a physician location in municipalities on adenoma and cancer detection rates was studied using Poisson regression.
  
  
  RESULTS
  World-standardized adenoma detection rate was significantly higher in urban areas (102 [95% CI: 97-107]) than in rural areas (78 [95% CI: 72-84]). The impact of the absence of physicians in municipalities was only found in rural areas. The detection rate ratio associated with the absence of a primary care physician was 0.70 [95% CI: 0.61-0.81], and the detection rate ratio associated with the absence of a gastroenterologist was 0.75 [95% CI: 0.64-0.89]. Colorectal cancer incidence rates were similar in urban and rural areas with only marginal variations related to physician location.
  
  
  CONCLUSIONS
  These results suggested a differential impact of geographical variables on the detection rates of colorectal adenomas and cancers in the population. Further studies are needed to examine socio-economic factors likely to be involved in these disparities.
authors: INSERM, CIE1, France. isabelle.fournel@chu-dijon.fr
authors: Isabelle
authors: I
authors: Fournel
authors: Vanessa
authors: V
authors: Cottet
authors: Christine
authors: C
authors: Binquet
authors: Valérie
authors: V
authors: Jooste
authors: Jean
authors: J
authors: Faivre
authors: Anne Marie
authors: AM
authors: Bouvier
authors: Claire
authors: C
authors: Bonithon-Kopp
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005602:France / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D015996:Survival Rate / Q000639:trends; D014505:Urban Population / Q000706:statistics & numerical data*