Inequalities in premature death from colorectal cancer by state.
OBJECTIVE
Although disparities in colorectal cancer (CRC) with regard to race, socioeconomic status, and geography are well documented, the extent to which these factors contribute to premature death resulting from CRC nationwide and by state is unknown.


METHODS
We calculated age-standardized CRC death rates for three broad educational categories as a marker of socioeconomic status by race/ethnicity and state among individuals age 25 to 64 years from 2008 through 2010. We also calculated the proportion of premature death resulting from CRC that could potentially be averted in each state by applying the average death rate for the five states with the lowest rates among the most educated whites (Connecticut, North Dakota, Utah, Vermont, and Wisconsin) to all populations.


RESULTS
Compared with those with the most education, those with the least education had significantly higher CRC death rates in virtually all states for each racial/ethnic group. For example, rate ratios ranged from 1.15 (95% CI, 0.66 to 2.01) in Delaware to 3.18 (95% CI, 2.01 to 5.05) in New Mexico among whites. Overall, half the premature deaths resulting from CRC that occurred nationwide from 2008 through 2010, or 7,690 deaths annually, would have been avoided if everyone had experienced the lowest death rates of the most educated whites. More premature deaths could be averted in southern states (60% to 70%) than in northern and western states (30% to 40%). Restricting the analyses to persons age 50 to 64 years, for whom CRC screening is recommended, resulted in similar findings.


CONCLUSIONS
The majority of premature deaths from CRC in southern states and half these deaths nationwide are due to racial/ethnic, socioeconomic, and geographic inequalities.
All authors, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA. ahmedin.jemal@cancer.org.
Ahmedin
A
Jemal
All authors, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA.
Rebecca L
RL
Siegel
All authors, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA.
Jiemin
J
Ma
All authors, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA.
Farhad
F
Islami
All authors, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA.
Carol
C
DeSantis
All authors, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA.
Ann
A
Goding Sauer
All authors, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA.
Edgar P
EP
Simard
All authors, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA.
Elizabeth M
EM
Ward
D000328:Adult; D001741:Black or African American; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality*; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature; D012307:Risk Factors; D012923:Social Class; D014481:United States