title: Prevalence of colorectal cancer screening among a multimorbid rural Appalachian population.
abstract: OBJECTIVE
  The purpose of this study was to determine the relation among multiple morbidities and the prevalence of colorectal cancer (CRC) screening among older adult Appalachian residents of Kentucky. This is the first known study to address multiple morbidities exclusively with a health-disparities population.
  
  
  METHODS
  This was a cross-sectional study of 1153 subjects, aged 50 to 76 years, from Appalachian Kentucky.
  
  
  RESULTS
  White race, post-high school education, and perception of having more than enough income on which to survive were associated with higher rates of any guideline concordant CRC screening. Statistically significant trends in the outcome of adjusted odds ratios for colonoscopy with greater number of morbidities (P < 0.05) were noted; the higher number of morbidities, the higher rates of screening.
  
  
  CONCLUSIONS
  Contrary to much existing research, within a health-disparities population, we found a dose-response relation between comorbidities and greater likelihood of CRC screening. Future research in this area should focus on explanations for this seldom-described finding. In addition, this finding has meaningful clinical and behavioral implications, including ensuring provider screening recommendation during routine office visits and outreach, perhaps through community clinics and public health departments, to extremely vulnerable populations lacking access to preventive care.
authors.affiliation: University of Kentucky College of Public Health and the College of Medicine, Lexington, KY, USA. stflem2@uky.edu
authors.forename: Steven T
authors.initials: ST
authors.lastname: Fleming
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Schoenberg
authors.forename: Yelena N
authors.initials: YN
authors.lastname: Tarasenko
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Pearce
mesh_terms: D000368:Aged; D001061:Appalachian Region / Q000453:epidemiology; D016009:Chi-Square Distribution; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007629:Kentucky / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data*
references.citation: Med Care. 2007 Jun;45(6):480-8
references.pmid: 17515774
references.citation: Arch Intern Med. 2005 Oct 10;165(18):2090-5
references.pmid: 16216998
references.citation: Soc Sci Med. 2005 Mar;60(5):1047-60
references.pmid: 15589673
references.citation: Prev Med. 2003 Mar;36(3):352-62
references.pmid: 12634026
references.citation: J Community Health. 1994 Aug;19(4):239-52
references.pmid: 7929885
references.citation: Arch Intern Med. 2006 Nov 13;166(20):2209-14
references.pmid: 17101938
references.citation: Ann Fam Med. 2003 May-Jun;1(1):8-14
references.pmid: 15043174
references.citation: J Gen Intern Med. 2004 Jun;19(6):632-7
references.pmid: 15209601
references.citation: Rural Remote Health. 2011;11(1):1553
references.pmid: 21280973
references.citation: J Health Care Poor Underserved. 2001 Feb;12(1):5-19
references.pmid: 11217227
references.citation: Prev Med. 1996 May-Jun;25(3):327-38
references.pmid: 8781011
references.citation: Ann Fam Med. 2006 Jan-Feb;4(1):32-9
references.pmid: 16449394
references.citation: J Am Geriatr Soc. 2002 Oct;50(10):1651-8
references.pmid: 12366618
references.citation: J Am Geriatr Soc. 2004 Oct;52(10):1688-95
references.pmid: 15450046
references.citation: Ann Intern Med. 2008 Nov 4;149(9):627-37
references.pmid: 18838716
references.citation: CA Cancer J Clin. 2010 Mar-Apr;60(2):99-119
references.pmid: 20228384
references.citation: Soc Sci Med. 1998 Dec;47(12):2113-25
references.pmid: 10075251
references.citation: Prev Med. 1999 Apr;28(4):386-94
references.pmid: 10090868
references.citation: Prev Med. 2000 Aug;31(2 Pt 1):167-76
references.pmid: 10938218