title: Geographic residency status and census tract socioeconomic status as determinants of colorectal cancer outcomes.
abstract: OBJECTIVE
  We examined the impact of geographic residency status and census tract (CT)-level socioeconomic status (SES) on colorectal cancer (CRC) outcomes.
  
  
  METHODS
  This was a retrospective cohort study of patients diagnosed with CRC in Georgia for the years 2000 through 2007. Study outcomes were late-stage disease at diagnosis, receipt of treatment, and survival.
  
  
  RESULTS
  For colon cancer, residents of lower-middle-SES and low-SES census tracts had decreased odds of receiving surgery. Rural, lower-middle-SES, and low-SES residents had decreased odds of receiving chemotherapy. For patients with rectal cancer, suburban residents had increased odds of receiving radiotherapy, but low SES resulted in decreased odds of surgery. For survival, rural residents experienced a partially adjusted 14% (hazard ratio [HR] = 1.14; 95% confidence interval [CI] = 1.07, 1.22) increased risk of death following diagnosis of CRC that was somewhat explained by treatment differences and completely explained by CT-level SES. Lower-middle- and low-SES participants had an adjusted increased risk of death following diagnosis for CRC (lower-middle: HR = 1.16; 95% CI = 1.10, 1.22; low: HR = 1.24; 95% CI = 1.16, 1.32).
  
  
  CONCLUSIONS
  Future efforts should focus on developing interventions and policies that target rural residents and lower SES areas to eliminate disparities in CRC-related outcomes.
authors.affiliation: Robert Hines and Frank Dong are with the Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Wichita. At the time of the study, Talar Markossian was with the Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Asal Johnson is with the Center for International Studies, Georgia Southern University. Rana Bayakly is with the Chronic Disease, Healthy Behaviors and Injury Epidemiology Section, Health Protection Division, Georgia Department of Public Health, Atlanta.
authors.forename: Robert
authors.initials: R
authors.lastname: Hines
authors.forename: Talar
authors.initials: T
authors.lastname: Markossian
authors.forename: Asal
authors.initials: A
authors.lastname: Johnson
authors.forename: Frank
authors.initials: F
authors.lastname: Dong
authors.forename: Rana
authors.initials: R
authors.lastname: Bayakly
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019352:Censuses; D015179:Colorectal Neoplasms / Q000145:classification / Q000401:mortality / Q000628:therapy; D016001:Confidence Intervals; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012042:Registries; D012111:Residence Characteristics; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D017678:Sex Distribution; D012923:Social Class; D016019:Survival Analysis