State Disparities in Colorectal Cancer Mortality Patterns in the United States

Background: Colorectal cancer (CRC) mortality rates have been decreasing for many decades in the United States, with the decrease accelerating in the most recent time period. The extent to which this decrease varies across states and its influence on the geographic patterns of rates is unknown. Methods: We analyzed the temporal trend in age-standardized CRC death rates for each state from 1990 to 2007 using joinpoint regression. We also examined the change in death rates between 1990–1994 and 2003–2007 using rate ratios with 95% confidence intervals and illustrated the change in pattern using maps. The relationship between the change in mortality rates and CRC screening rates for 2004 by state was examined using Pearson's correlation. Results: CRC mortality rates significantly decreased in all states except Mississippi between 1990 and 2007 based on the joinpoint model. The decrease in death rates between 1990–1994 and 2003–2007 ranged from 9% in Alabama to greater than 33% in Massachusetts, Rhode Island, New York, and Alaska; Mississippi and Wyoming showed no significant decrease. Generally, the northeastern states showed the largest decreases, whereas southern states showed the smallest decreases. The highest CRC mortality rates shifted from the northeastern states during 1990 to 1994 to the southern states along the Appalachian corridor during 2003 to 2007. The decrease in CRC mortality rates by state correlated strongly with uptake of screening (r = −0.65, P < 0.0001). Conclusions: Progress in reducing CRC mortality varies across states, with the Northeast showing the most progress and the South showing the least progress. Impact: These findings highlight the need for wider dissemination of CRC screening. Cancer Epidemiol Biomarkers Prev; 20(7); 1296–302. ©2011 AACR.

[1]  Bruce Behringer,et al.  Appalachia: Where Place Matters in Health , 2006, Preventing chronic disease.

[2]  Michael J Thun,et al.  Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. , 2003, The New England journal of medicine.

[3]  J. Goodwin,et al.  Neighborhood Composition and Cancer among Hispanics: Tumor Stage and Size at Time of Diagnosis , 2008, Cancer Epidemiology Biomarkers & Prevention.

[4]  E. Feuer,et al.  Permutation tests for joinpoint regression with applications to cancer rates. , 2000, Statistics in medicine.

[5]  Victor Kipnis,et al.  Dietary patterns as identified by factor analysis and colorectal cancer among middle-aged Americans. , 2008, The American journal of clinical nutrition.

[6]  S. Devesa,et al.  Emerging and Widening Colorectal Carcinoma Disparities Between Blacks and Whites in the United States (1975-2002) , 2006, Cancer Epidemiology Biomarkers & Prevention.

[7]  A. Jemal,et al.  Annual report to the nation on the status of cancer, 1975‐2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates , 2010, Cancer.

[8]  L. Seeff,et al.  Colorectal cancer-screening tests and associated health behaviors. , 2001, American journal of preventive medicine.

[9]  J. Bray.  Response to increases in cigarette prices by race/ethnicity, income, and age groups--United States, 1976-1993. , 1997, MMWR. Morbidity and mortality weekly report.

[10]  Nikki L. Lyttle,et al.  Assessing Awareness and Knowledge of Breast and Cervical Cancer Among Appalachian Women , 2006, Preventing chronic disease.

[11]  Ram C Tiwari,et al.  Interval Estimation for Ratios of Correlated Age-Adjusted Rates. , 2010, Journal of data science : JDS.

[12]  Susan Bolick-Aldrich,et al.  Cancer in Appalachia, 2001–2003 , 2008, Cancer.

[13]  J. R. Scotti,et al.  Available From , 1973 .

[14]  A. Jemal,et al.  Race, neighbourhood characteristics and disparities in chemotherapy for colorectal cancer , 2009, Journal of Epidemiology & Community Health.

[15]  Scienze Politiche.  American Community Survey , 2011 .

[16]  L. Boardman,et al.  Colorectal Cancer in African Americans , 2005, The American Journal of Gastroenterology.

[17]  Xianglin L. Du,et al.  Racial and Ethnic Disparities in Colorectal Cancer Screening Persisted Despite Expansion of Medicare's Screening Reimbursement , 2011, Cancer Epidemiology, Biomarkers & Prevention.

[18]  S. Coughlin,et al.  Colorectal carcinoma mortality among Appalachian men and women, 1969–1999 , 2004, Cancer.

[19]  N. Dubrawsky.  Cancer statistics , 1989, CA: a cancer journal for clinicians.

[20]  David J Lee,et al.  Cancer Incidence in First Generation U.S. Hispanics: Cubans, Mexicans, Puerto Ricans, and New Latinos , 2009, Cancer Epidemiology, Biomarkers & Prevention.

[21]  Rascon.  [The National Cancer Institute]. , 1953, Boletin cultural e informativo - Consejo General de Colegios Medicos de Espana.

[22]  P. Maisonneuve,et al.  Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps. , 2008, Gastroenterology.

[23]  J. Fulton,et al.  Subsite‐specific incidence rate and stage of disease in colorectal cancer by race, gender, and age group in the United States, 1992–1997 , 2001, Cancer.

[24]  William J. Blot,et al.  Atlas of Cancer Mortality in the United States 1950-94 , 2000 .

[25]  S. J. Henley,et al.  Surveillance of screening-detected cancers (colon and rectum, breast, and cervix) - United States, 2004-2006. , 2010, Morbidity and mortality weekly report. Surveillance summaries.

[26]  H. Brenner,et al.  No Evidence for Variation in Colorectal Cancer Risk Associated With Different Types of Postmenopausal Hormone Therapy , 2009, Clinical pharmacology and therapeutics.

[27]  Perry J Pickhardt,et al.  Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi‐Society Task Force on Colorectal Cancer, and the American College of Radiology * † , 2008, CA: a cancer journal for clinicians.

[28]  D. Lieberman.  Screening/early detection model for colorectal cancer. Why screen? , 1994, Cancer.

[29]  Deborah Schrag,et al.  Annual report to the nation on the status of cancer, 1975-2002, featuring population-based trends in cancer treatment. , 2005, Journal of the National Cancer Institute.

[30]  D. Martinez-Tyson,et al.  Looking Under the Hispanic Umbrella: Cancer Mortality Among Cubans, Mexicans, Puerto Ricans and Other Hispanics in Florida , 2008, Journal of Immigrant and Minority Health.

[31]  W. Spanos,et al.  Disparities in the application of adjuvant radiotherapy after breast‐conserving surgery for early stage breast cancer , 2011, Cancer.

[32]  M. Nadel,et al.  Incidence of dysplasia and carcinoma of the uterine cervix in an Appalachian population. , 1992, Journal of the National Cancer Institute.

[33]  L. Balluz,et al.  Differences in prevalence of obesity among black, white, and Hispanic adults - United States, 2006-2008. , 2009, MMWR. Morbidity and mortality weekly report.

[34]  Ali H Mokdad,et al.  Public health surveillance for behavioral risk factors in a changing environment. Recommendations from the Behavioral Risk Factor Surveillance Team. , 2003, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[35]  T. Ricketts,et al.  Colon cancer treatment in rural North and South Carolina. , 1999, Cancer detection and prevention.

[36]  R. Capocaccia,et al.  Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence , 2001, Gut.

[37]  Xiao-Cheng Wu,et al.  Annual Report to the Nation on the Status of Cancer, 1975–2005, Featuring Trends in Lung Cancer, Tobacco Use, and Tobacco Control , 2008, Journal of the National Cancer Institute.

[38]  A. P. Ortiz,et al.  Incidence and mortality rates for colorectal cancer in Puerto Rico and among Hispanics, non-Hispanic whites, and non-Hispanic blacks in the United States, 1998-2002 (Cancer (2009) 115, (3016-3023)) , 2009 .

[39]  Aliza K Fink,et al.  The accuracy of cancer mortality statistics based on death certificates in the United States. , 2011, Cancer epidemiology.

[40]  J. Zell,et al.  Effects of Socioeconomic Status and Treatment Disparities in Colorectal Cancer Survival , 2008, Cancer Epidemiology Biomarkers & Prevention.

[41]  A. Poullis,et al.  Chronic subclinical bowel inflammation may explain increased risk of colorectal cancer in obese people , 2007, Gut.

[42]  G. Colditz,et al.  Postmenopausal Hormone Use and Risk for Colorectal Cancer and Adenoma , 1998, Annals of Internal Medicine.

[43]  K. Pearson,et al.  DETERMINATION OF THE COEFFICIENT OF CORRELATION. , 1909, Science.

[44]  B. Levin,et al.  Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. , 2008, Gastroenterology.

[45]  A. P. Ortiz,et al.  Incidence and mortality rates for colorectal cancer in Puerto Rico and among Hispanics, non‐Hispanic whites, and non‐Hispanic blacks in the United States, 1998‐2002 , 2009, Cancer.

[46]  A. Jemal,et al.  Annual report to the nation on the status of cancer, 1975-2000, featuring the uses of surveillance data for cancer prevention and control. , 2003, Journal of the National Cancer Institute.

[47]  E. Arias,et al.  The validity of race and Hispanic origin reporting on death certificates in the United States. , 2008, Vital and health statistics. Series 2, Data evaluation and methods research.

[48]  E. Perez-stable,et al.  Effectiveness of disseminating culturally appropriate smoking-cessation information: Programa Latino Para Dejar de Fumar. , 1995, Journal of the National Cancer Institute. Monographs.

[49]  Paul Cleary,et al.  Use of Hormone Replacement Therapy by Postmenopausal Women in the United States , 1999, Annals of Internal Medicine.

[50]  Xiaocheng Wu,et al.  Annual report to the nation on the status of cancer, 1975–2003, featuring cancer among U.S. Hispanic/Latino populations , 2006, Cancer.

[51]  S. Bass,et al.  Increasing colorectal cancer screening among African Americans, linking risk perception to interventions targeting patients, communities and clinicians. , 2008, Journal of the National Medical Association.

[52]  A. Jemal,et al.  Cancer Statistics, 2010 , 2010, CA: a cancer journal for clinicians.

[53]  S. Dube,et al.  Adult tobacco survey - 19 States, 2003-2007. , 2010, Morbidity and mortality weekly report. Surveillance summaries.

[54]  J. Mandelblatt,et al.  The late-stage diagnosis of colorectal cancer: demographic and socioeconomic factors. , 1996, American journal of public health.

[55]  Victor R. Preedy,et al.  Behavioral Risk Factor Surveillance System , 2010 .