title: Associations of census-tract poverty with subsite-specific colorectal cancer incidence rates and stage of disease at diagnosis in the United States.
abstract: Background. It remains unclear whether neighborhood poverty contributes to differences in subsite-specific colorectal cancer (CRC) incidence. We examined associations between census-tract poverty and CRC incidence and stage by anatomic subsite and race/ethnicity. Methods. CRC cases diagnosed between 2005 and 2009 from 15 states and Los Angeles County (N = 278,097) were assigned to 1 of 4 groups based on census-tract poverty. Age-adjusted and stage-specific CRC incidence rates (IRs) and incidence rate ratios (IRRs) were calculated. Analyses were stratified by subsite (proximal, distal, and rectum), sex, race/ethnicity, and poverty. Results. Compared to the lowest poverty areas, CRC IRs were significantly higher in the most impoverished areas for men (IRR = 1.14 95% CI 1.12-1.17) and women (IRR = 1.06 95% CI 1.05-1.08). Rate differences between high and low poverty were strongest for distal colon (male IRR = 1.24 95% CI 1.20-1.28; female IRR = 1.14 95% CI 1.10-1.18) and weakest for proximal colon. These rate differences were significant for non-Hispanic whites and blacks and for Asian/Pacific Islander men. Inverse associations between poverty and IRs of all CRC and proximal colon were found for Hispanics. Late-to-early stage CRC IRRs increased monotonically with increasing poverty for all race/ethnicity groups. Conclusion. There are differences in subsite-specific CRC incidence by poverty, but associations were moderated by race/ethnicity.
authors.affiliation: Department of Epidemiology, Rutgers School of Public Health and Rutgers Cancer Institute of New Jersey, 683 Hoes Lane West, Piscataway, NJ 08854, USA.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Henry
authors.affiliation: North American Association of Central Cancer Registries, 2121 West White Oaks Drive, Suite B, Springfield, IL 62704, USA.
authors.forename: Recinda L
authors.initials: RL
authors.lastname: Sherman
authors.affiliation: Department of Geography, University of Utah, 260 South Central Campus Drive Room 270, Salt Lake City, UT 84112-9155, USA.
authors.forename: Kaila
authors.identifier: 0000-0002-1157-3934
authors.initials: K
authors.lastname: McDonald
authors.affiliation: Cancer Data Registry of Idaho, 615 North 7th Street, P.O. Box 1278, Boise, ID 83701, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Johnson
authors.affiliation: Department of Health Services Research and Administration, University of Nebraska Medical Center, College of Public Health, Nebraska Medical Center, Omaha, NE 68198-4350, USA.
authors.forename: Ge
authors.initials: G
authors.lastname: Lin
authors.affiliation: Department of Epidemiology, Rutgers School of Public Health and Rutgers Cancer Institute of New Jersey, 683 Hoes Lane West, Piscataway, NJ 08854, USA.
authors.forename: Antoinette M
authors.initials: AM
authors.lastname: Stroup
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, University of Albany, State University of New York, Albany, One University Place, Rensselaer, NY 12144, USA.
authors.forename: Francis P
authors.initials: FP
authors.lastname: Boscoe