title: Geographical variation and factors associated with colorectal cancer mortality in a universal health care system.
abstract: OBJECTIVE
  To investigate the geographical variation and small geographical area level factors associated with colorectal cancer (CRC) mortality.
  
  
  METHODS
  Information regarding CRC mortality was obtained from the population-based Manitoba Cancer Registry, population counts were obtained from Manitoba's universal health care plan Registry and characteristics of the area of residence were obtained from the 2001 Canadian census. Bayesian spatial Poisson mixed models were used to evaluate the geographical variation of CRC mortality and Poisson regression models for determining associations with CRC mortality. Time trends of CRC mortality according to income group were plotted using joinpoint regression.
  
  
  RESULTS
  The southeast (mortality rate ratio [MRR] 1.31 [95% CI 1.12 to 1.54) and southcentral (MRR 1.62 [95% CI 1.35 to 1.92]) regions of Manitoba had higher CRC mortality rates than suburban Winnipeg (Manitoba's capital city). Between 1985 and 1996, CRC mortality did not vary according to household income; however, between 1997 and 2009, individuals residing in the highest-income areas were less likely to die from CRC (MRR 0.77 [95% CI 0.65 to 0.89]). Divergence in CRC mortality among individuals residing in different income areas increased over time, with rising CRC mortality observed in the lowest income areas and declining CRC mortality observed in the higher income areas.
  
  
  CONCLUSIONS
  Individuals residing in lower income neighbourhoods experienced rising CRC mortality despite residing in a jurisdiction with universal health care and should receive increased efforts to reduce CRC mortality. These findings should be of particular interest to the provincial CRC screening programs, which may be able to reduce the disparities in CRC mortality by reducing the disparities in CRC screening participation.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Torabi
authors.forename: Christopher
authors.initials: C
authors.lastname: Green
authors.forename: Zoann
authors.initials: Z
authors.lastname: Nugent
authors.forename: Salaheddin
authors.initials: S
authors.lastname: Mahmud
authors.forename: Alain
authors.initials: A
authors.lastname: Demers
authors.forename: Jane
authors.initials: J
authors.lastname: Griffith
authors.forename: Harminder
authors.initials: H
authors.lastname: Singh
mesh_terms: D000368:Aged; D003106:Colon / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D012042:Registries; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D062211:Spatio-Temporal Analysis; D013383:Suburban Population / Q000706:statistics & numerical data; D019472:Universal Health Insurance; D014505:Urban Population / Q000706:statistics & numerical data
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