title: Assessing disparities in colorectal cancer mortality by socioeconomic status using new tools: health disparities calculator and socioeconomic quintiles.
abstract: Colorectal cancer mortality rates dropped by half in the past three decades, but these gains were accompanied by striking differences in colorectal cancer mortality by socioeconomic status (SES). Our research objective is to examine disparities in colorectal cancer mortality by SES, using a scientifically rigorous and reproducible approach with publicly available online tools, HD*Calc and NCI SES Quintiles.
  
  
  
  All reported colorectal cancer deaths in the United States from 1980 to 2010 were categorized into NCI SES quintiles and assessed at the county level. Joinpoint was used to test for significant changes in trends. Absolute and relative concentration indices (CI) were computed with HD*Calc to graph change in disparity over time.
  
  
  
  Disparities by SES significantly declined until 1993-1995, and then increased until 2010, due to a mortality drop in populations living in high SES areas that exceeded the mortality drop in lower SES areas. HD*Calc results were consistent for both absolute and relative concentration indices. Inequality aversion parameter weights of 2, 4, 6 and 8 were compared to explore how much colorectal cancer mortality was concentrated in the poorest quintile compared to the richest quintile. Weights larger than 4 did not increase the slope of the disparities trend.
  
  
  
  There is consistent evidence for a significant crossover in colorectal cancer disparity from 1980 to 2010. Trends in disparity can be accurately and readily summarized using the HD*Calc tool. The disparity trend, combined with published information on the timing of screening and treatment uptake, is concordant with the idea that introduction of medical screening and treatment leads to lower uptake in lower compared to higher SES populations and that differential uptake yields disparity in population mortality.
authors.affiliation: Division of Cancer Control and Population Sciences, National Cancer Institute, 6707 Democracy Blvd, Suite 800 MSC 5465, Bethesda, MD, 20892-5465, USA. Breenn@mail.nih.gov.|Office of Science Policy, Planning, Analysis and Reporting, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA. Breenn@mail.nih.gov.
authors.forename: Nancy
authors.identifier: 0000-0003-3860-6860
authors.initials: N
authors.lastname: Breen
authors.affiliation: Division of Cancer Control and Population Sciences, National Cancer Institute, 6707 Democracy Blvd, Suite 800 MSC 5465, Bethesda, MD, 20892-5465, USA.
authors.forename: Denise Riedel
authors.initials: DR
authors.lastname: Lewis
authors.affiliation: Information Management Services Incorporated, Beltsville, MD, USA.
authors.forename: James Todd
authors.initials: JT
authors.lastname: Gibson
authors.affiliation: Division of Cancer Control and Population Sciences, National Cancer Institute, 6707 Democracy Blvd, Suite 800 MSC 5465, Bethesda, MD, 20892-5465, USA.
authors.forename: Mandi
authors.initials: M
authors.lastname: Yu
authors.affiliation: McGill University, Montreal, Quebec, Canada.
authors.forename: Sam
authors.initials: S
authors.lastname: Harper
mesh_terms: D003110:Colonic Neoplasms / Q000401:mortality*; D054624:Health Status Disparities; D006801:Humans; D011203:Poverty; D012004:Rectal Neoplasms / Q000401:mortality*; D012923:Social Class; D012959:Socioeconomic Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
keywords: Colorectal Cancer Mortality; Concentration Index; Disparities; HD*Calc; Inequality Aversion Parameter; SES Quintiles