The Influence of Poverty and Rurality on Colorectal Cancer Survival by Race/Ethnicity: An Analysis of SEER Data with a Census Tract-Level Measure of Persistent Poverty
<b>Purpose:</b> Because of shared mechanisms such as decreased access to health care, rurality and poverty may act synergistically to decrease colorectal cancer (CRC) survival. <b>Methods:</b> We conducted a retrospective cohort analysis of SEER data (22 registries) with cens...
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MDPI AG
2025-04-01
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| Series: | Current Oncology |
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| Online Access: | https://www.mdpi.com/1718-7729/32/5/248 |
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| author | Steven S. Coughlin Meng-Han Tsai Jorge Cortes Malcolm Bevel Marlo Vernon |
| author_facet | Steven S. Coughlin Meng-Han Tsai Jorge Cortes Malcolm Bevel Marlo Vernon |
| author_sort | Steven S. Coughlin |
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| description | <b>Purpose:</b> Because of shared mechanisms such as decreased access to health care, rurality and poverty may act synergistically to decrease colorectal cancer (CRC) survival. <b>Methods:</b> We conducted a retrospective cohort analysis of SEER data (22 registries) with census tract-level measures of poverty/rurality for the period 2006–2015. Multivariable Cox proportional hazard regressions were applied to examine the independent and intersectional associations of persistent poverty and rurality on 5-year cause-specific CRC survival across five racial/ethnic groups. <b>Results:</b> Among 532,868 CRC patients, non-Hispanic Blacks (NHB) demonstrated lower 5-year survival probability (64.2% vs. 68.3% in non-Hispanic Whites [NHW], 66.5% in American Indian/Alaska Natives [AI/AN], 72.1% in Asian/Pacific Islanders, and 68.7% in Hispanic groups) (<i>p</i>-value < 0.001). In adjusted analysis, CRC patients living in rural areas with poverty were at a 1.2–1.6-fold increased risk of CRC death than those who did not live in these areas in five racial/ethnic groups. In particular, AI/AN patients living in rural areas with poverty were 66% more likely to die from CRC (95% CI, 1.32, 2.08). <b>Conclusions:</b> CRC patients who live in rural or poverty areas in SEER areas in the U.S. have a poorer survival compared with those who do not live in such areas regardless of race/ethnicity. Significantly greater risk of CRC death was observed in AI/ANs. <b>Impact:</b> Patient navigators, community education or screening, and other health care system interventions may be helpful to address these disparities by socioeconomic status, race, and geographic residence. Multi-level interventions aimed at institutional racism and medical mistrust may also be helpful. |
| format | Article |
| id | doaj-art-ddba47cc0a4f409b928c6dfd16d37334 |
| institution | DOAJ |
| issn | 1198-0052 1718-7729 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | MDPI AG |
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| series | Current Oncology |
| spelling | doaj-art-ddba47cc0a4f409b928c6dfd16d373342025-08-20T03:14:39ZengMDPI AGCurrent Oncology1198-00521718-77292025-04-0132524810.3390/curroncol32050248The Influence of Poverty and Rurality on Colorectal Cancer Survival by Race/Ethnicity: An Analysis of SEER Data with a Census Tract-Level Measure of Persistent PovertySteven S. Coughlin0Meng-Han Tsai1Jorge Cortes2Malcolm Bevel3Marlo Vernon4Department of Biostatistics, Data Science and Epidemiology, Augusta University, Augusta, GA 30912, USAGeorgia Prevention Institute, Augusta University, Augusta, GA 30912, USAGeorgia Cancer Center, Augusta University, Augusta, GA 30912, USACancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Augusta University, Augusta, GA 30912, USAGeorgia Prevention Institute, Augusta University, Augusta, GA 30912, USA<b>Purpose:</b> Because of shared mechanisms such as decreased access to health care, rurality and poverty may act synergistically to decrease colorectal cancer (CRC) survival. <b>Methods:</b> We conducted a retrospective cohort analysis of SEER data (22 registries) with census tract-level measures of poverty/rurality for the period 2006–2015. Multivariable Cox proportional hazard regressions were applied to examine the independent and intersectional associations of persistent poverty and rurality on 5-year cause-specific CRC survival across five racial/ethnic groups. <b>Results:</b> Among 532,868 CRC patients, non-Hispanic Blacks (NHB) demonstrated lower 5-year survival probability (64.2% vs. 68.3% in non-Hispanic Whites [NHW], 66.5% in American Indian/Alaska Natives [AI/AN], 72.1% in Asian/Pacific Islanders, and 68.7% in Hispanic groups) (<i>p</i>-value < 0.001). In adjusted analysis, CRC patients living in rural areas with poverty were at a 1.2–1.6-fold increased risk of CRC death than those who did not live in these areas in five racial/ethnic groups. In particular, AI/AN patients living in rural areas with poverty were 66% more likely to die from CRC (95% CI, 1.32, 2.08). <b>Conclusions:</b> CRC patients who live in rural or poverty areas in SEER areas in the U.S. have a poorer survival compared with those who do not live in such areas regardless of race/ethnicity. Significantly greater risk of CRC death was observed in AI/ANs. <b>Impact:</b> Patient navigators, community education or screening, and other health care system interventions may be helpful to address these disparities by socioeconomic status, race, and geographic residence. Multi-level interventions aimed at institutional racism and medical mistrust may also be helpful.https://www.mdpi.com/1718-7729/32/5/248incomepovertyraceruralitysocial determinants of health |
| spellingShingle | Steven S. Coughlin Meng-Han Tsai Jorge Cortes Malcolm Bevel Marlo Vernon The Influence of Poverty and Rurality on Colorectal Cancer Survival by Race/Ethnicity: An Analysis of SEER Data with a Census Tract-Level Measure of Persistent Poverty Current Oncology income poverty race rurality social determinants of health |
| title | The Influence of Poverty and Rurality on Colorectal Cancer Survival by Race/Ethnicity: An Analysis of SEER Data with a Census Tract-Level Measure of Persistent Poverty |
| title_full | The Influence of Poverty and Rurality on Colorectal Cancer Survival by Race/Ethnicity: An Analysis of SEER Data with a Census Tract-Level Measure of Persistent Poverty |
| title_fullStr | The Influence of Poverty and Rurality on Colorectal Cancer Survival by Race/Ethnicity: An Analysis of SEER Data with a Census Tract-Level Measure of Persistent Poverty |
| title_full_unstemmed | The Influence of Poverty and Rurality on Colorectal Cancer Survival by Race/Ethnicity: An Analysis of SEER Data with a Census Tract-Level Measure of Persistent Poverty |
| title_short | The Influence of Poverty and Rurality on Colorectal Cancer Survival by Race/Ethnicity: An Analysis of SEER Data with a Census Tract-Level Measure of Persistent Poverty |
| title_sort | influence of poverty and rurality on colorectal cancer survival by race ethnicity an analysis of seer data with a census tract level measure of persistent poverty |
| topic | income poverty race rurality social determinants of health |
| url | https://www.mdpi.com/1718-7729/32/5/248 |
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