title: Differences in late-stage diagnosis, treatment, and colorectal cancer-related death between rural and urban African Americans and whites in Georgia.
abstract: OBJECTIVE
  Disparities in health outcomes due to a diagnosis of colorectal cancer (CRC) have been reported for a number of demographic groups. This study was conducted to examine the outcomes of late-stage diagnosis, treatment, and cancer-related death according to race and geographic residency status (rural vs urban).
  
  
  METHODS
  This study utilized cross-sectional and follow-up data from the Surveillance, Epidemiology, and End Results (SEER) Program for all incident colon and rectal tumors diagnosed for the Atlanta and Rural Georgia Cancer Registries for the years 1992-2007.
  
  
  RESULTS
  Compared to whites, African Americans had a 40% increased odds (OR, 1.40; 95% CI, 1.30-1.51) of late-stage diagnosis, a 50% decreased odds (OR, 0.50; 95% CI, 0.37-0.68) of having surgery for colon cancer, and a 67% decreased odds (OR, 0.33; 95% CI, 0.25-0.44) of receiving surgery for rectal cancer. Rural residence was not associated with late stage at diagnosis or receipt of treatment. African Americans had a slightly increased risk of death from colon cancer (HR, 1.11; 95% CI, 1.00-1.24) and a larger increased risk of death due to rectal cancer (HR, 1.24; 95% CI, 1.14-1.35). Rural residents experienced a 15% increased risk of death (HR, 1.15; 95% CI, 1.01-1.32) due to colon cancer.
  
  
  CONCLUSIONS
  Further investigations should target African Americans and rural residents to gain insight into the etiologic mechanisms responsible for the poorer CRC outcomes experienced by these 2 segments of the population.
authors: Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia 30460-8015, USA. rhines@georgiasouthern.edu
authors: Robert B
authors: RB
authors: Hines
authors: Talar W
authors: TW
authors: Markossian
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D005260:Female; D005500:Follow-Up Studies; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012424:Rural Population / Q000706:statistics & numerical data*; D018426:SEER Program; D012923:Social Class; D014505:Urban Population / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*