title: Fundamental causes of colorectal cancer mortality in the United States: understanding the importance of socioeconomic status in creating inequality in mortality.
abstract: OBJECTIVE
  We used the fundamental cause hypothesis as a framework for understanding the creation of health disparities in colorectal cancer mortality in the United States from 1968 to 2005.
  
  
  METHODS
  We used negative binomial regression to analyze trends in county-level gender-, race-, and age-adjusted colorectal cancer mortality rates among individuals aged 35 years or older.
  
  
  RESULTS
  Prior to 1980, there was a stable gradient in colorectal cancer mortality, with people living in counties of higher socioeconomic status (SES) being at greater risk than people living in lower SES counties. Beginning in 1980, this gradient began to narrow and then reversed as people living in higher SES counties experienced greater reductions in colorectal cancer mortality than those in lower SES counties.
  
  
  CONCLUSIONS
  Our findings support the fundamental cause hypothesis: once knowledge about prevention and treatment of colorectal cancer became available, social and economic resources became increasingly important in influencing mortality rates.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. nallely_saldana-ruiz@urmc.rochester.edu
authors.forename: Nallely
authors.initials: N
authors.lastname: Saldana-Ruiz
authors.forename: Sean A P
authors.initials: SA
authors.lastname: Clouston
authors.forename: Marcie S
authors.initials: MS
authors.lastname: Rubin
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Colen
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Link
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000517:prevention & control; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D012923:Social Class; D014481:United States / Q000453:epidemiology