The impact of preventive screening resource distribution on geographic and population-based disparities in colorectal cancer in Mississippi.
BACKGROUND
The state of Mississippi has the highest colorectal cancer (CRC) mortality rate in the USA. The geographic distribution of CRC screening resources and geographic- and population-based CRC characteristics in Mississippi are investigated to reveal the geographic disparity in CRC screening.


METHODS
The primary practice sites of licensed gastroenterologists and the addresses of licensed medical facilities offering on-site colonoscopies were verified via telephone surveys, then these CRC screening resource data were geocoded and analyzed using Geographic Information Systems. Correlation analyses were performed to detect the strength of associations between CRC screening resources, CRC screening behavior and CRC outcome data.


RESULTS
Age-adjusted colorectal cancer incidence rates, mortality rates, mortality-to-incidence ratios, and self-reported endoscopic screening rates from the years 2006 through 2010 were significantly different for Black and White Mississippians; Blacks fared worse than Whites in all categories throughout all nine Public Health Districts. CRC screening rates were negatively correlated with CRC incidence rates and CRC mortality rates. The availability of gastroenterologists varied tremendously throughout the state; regions with the poorest CRC outcomes tended to be underserved by gastroenterologists.


CONCLUSIONS
Significant population-based and geographic disparities in CRC screening behaviors and CRC outcomes exist in Mississippi. The effects of CRC screening resources are related to CRC screening behaviors and outcomes at a regional level, whereas at the county level, socioeconomic factors are more strongly associated with CRC outcomes. Thus, effective control of CRC in rural states with high poverty levels requires both adequate preventive CRC screening capacity and a strategy to address fundamental causes of health care disparities.
GIS and Remote Sensing Program, University of Mississippi Medical Center, Jackson, MS, 39216-4505, USA. ffaruque@umc.edu.
Fazlay S
FS
Faruque
Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, 39216-4505, USA. xzhang2@umc.edu.
Xu
X
Zhang
Murrah High School, Jackson, MS, 39216, USA. elizabeth.n.nichols@vanderbilt.edu.|Vanderbilt University, Nashville, TN, 37240, USA. elizabeth.n.nichols@vanderbilt.edu.
Elizabeth N
EN
Nichols
Murrah High School, Jackson, MS, 39216, USA. dlbradle@go.olemiss.edu.|University of Mississippi, Oxford, MS, 38677, USA. dlbradle@go.olemiss.edu.
Denae L
DL
Bradley
University of Pennsylvania, Philadelphia, PA, 19104, USA. roycer@sas.upenn.edu.
Royce
R
Reeves-Darby
GI Associates and Endoscopy Center, Jackson, MS, 39202, USA. vonda.reevesdarby@gastrodocs.net.
Vonda
V
Reeves-Darby
Department of Radiation Oncology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216-4505, USA. rduhe@umc.edu.|Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, 39216-4505, USA. rduhe@umc.edu.|UMMC Cancer Institute, University of Mississippi Medical Center, Jackson, MS, 39216-4505, USA. rduhe@umc.edu.
Roy J
RJ
Duhé
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000208:ethnology / Q000401:mortality / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005843:Geography; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D012042:Registries / Q000706:statistics & numerical data; D012423:Rural Health / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D012812:Sigmoidoscopy / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D015996:Survival Rate; D044465:White People / Q000706:statistics & numerical data