title: Colorectal cancer outcome inequalities: association between population density, race, and socioeconomic status.
abstract: BACKGROUND
  Conflicting data exists regarding the influence of population density on colorectal cancer (CRC) outcomes; to better understand this, the present study evaluated outcomes along an urban-rural continuum.
  
  
  METHODS
  Colorectal patients aged &#8805;40 years from 1992 to 2002 were identified in the SEER (Surveillance, Epidemiology, and End Results) Registries of the National Cancer Institute in the USA.
  
  
  RESULTS
  A total of 176 011 patients were identified, with median age 71; most lived in populous counties and were white (90%). Patients from large metropolitan counties were more often African-American, and those in rural counties were more likely to be white and have low socioeconomic status (SES). Patients from large metropolitan (>1 million) and rural counties were more likely to have metastatic disease and decreased survival compared to smaller metropolitan counties (<1 million). Late stage of presentation and diminished survival were also associated with African-American race, male sex and lower SES.
  
  
  CONCLUSIONS
  Metropolitan counties with populations <1 million had superior CRC outcomes, in part secondary to race and SES.
authors.affiliation: East Carolina Uinversity, Greenville, North Carolina, USA. fitzgeraldt@ecu.edu.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Fitzgerald
authors.affiliation: East Carolina Uinversity, Greenville, North Carolina, USA. leac@ecu.edu.
authors.forename: C S
authors.initials: CS
authors.lastname: Lea
authors.affiliation: East Carolina Uinversity, Greenville, North Carolina, USA. brindleyj@ecu.edu.
authors.forename: Jason
authors.initials: J
authors.lastname: Brinkley
authors.affiliation: East Carolina Uinversity, Greenville, North Carolina, USA. zervose@ecu.edu.
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Zervos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011156:Population Density; D018426:SEER Program; D012959:Socioeconomic Factors