title: Rural vs urban residence affects risk-appropriate colorectal cancer screening.
abstract: OBJECTIVE
  Little is known about the effects of geographic factors, such as rural vs urban residence and travel time to colonoscopy providers, on risk-appropriate use of colorectal cancer (CRC) screening in the general population. We evaluated the effects of geographic factors on adherence to CRC screening and differences in screening use among familial risk groups.
  
  
  METHODS
  We analyzed data from the 2010 Utah Behavior Risk Factor Surveillance System, which included state-added questions on familial CRC. By using multiple logistic regression models, we assessed the effects of rural vs urban residence, travel time to the nearest colonoscopy provider, and spatial accessibility of providers on adherence to risk-appropriate screening guidelines. Study participants (n = 4260) were respondents aged 50 to 75 years.
  
  
  RESULTS
  Sixty-six percent of the sample adhered to risk-appropriate CRC screening guidelines, with significant differences between urban and rural residents (68% vs 57%, respectively; P < .001) across all familial risk groups. Rural residents were less likely than urban dwellers to be up-to-date with screening guidelines (multivariate odds ratio, 0.65; 95% confidence interval, 0.53-0.79). In the unadjusted analysis, rural vs urban residence (P < .001), travel time to the nearest colonoscopy provider (P = .003), and spatial accessibility of providers (P = .012) were associated significantly with adherence to screening guidelines. However, rural vs urban residence (P < .001) was the only geographic variable independently associated with screening adherence in the adjusted analyses.
  
  
  CONCLUSIONS
  There are marked disparities in use of risk-appropriate CRC screening between rural and urban residents in Utah. Differences in travel time to the nearest colonoscopy provider and spatial accessibility of providers did not account for the geographic variations observed in screening adherence.
authors.affiliation: Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah 84112, USA.
authors.forename: Allison E
authors.initials: AE
authors.lastname: Anderson
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Henry
authors.forename: N Jewel
authors.initials: NJ
authors.lastname: Samadder
authors.forename: Ray M
authors.initials: RM
authors.lastname: Merrill
authors.forename: Anita Y
authors.initials: AY
authors.lastname: Kinney
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D012424:Rural Population; D011795:Surveys and Questionnaires; D014505:Urban Population; D014589:Utah