Associations of Census-Tract Poverty with Subsite-Specific Colorectal Cancer Incidence Rates and Stage of Disease at Diagnosis in the United States

Abstract EN

Background.

It remains unclear whether neighborhood poverty contributes to differences in subsite-specific colorectal cancer (CRC) incidence.

We examined associations between census-tract poverty and CRC incidence and stage by anatomic subsite and race/ethnicity.

Methods.

CRC cases diagnosed between 2005 and 2009 from 15 states and Los Angeles County (N=278,097) were assigned to 1 of 4 groups based on census-tract poverty.

Age-adjusted and stage-specific CRC incidence rates (IRs) and incidence rate ratios (IRRs) were calculated.

Analyses were stratified by subsite (proximal, distal, and rectum), sex, race/ethnicity, and poverty.

Results.

Compared to the lowest poverty areas, CRC IRs were significantly higher in the most impoverished areas for men (IRR = 1.14 95% CI 1.12–1.17) and women (IRR = 1.06 95% CI 1.05–1.08).

Rate differences between high and low poverty were strongest for distal colon (male IRR = 1.24 95% CI 1.20–1.28; female IRR = 1.14 95% CI 1.10–1.18) and weakest for proximal colon.

These rate differences were significant for non-Hispanic whites and blacks and for Asian/Pacific Islander men.

Inverse associations between poverty and IRs of all CRC and proximal colon were found for Hispanics.

Late-to-early stage CRC IRRs increased monotonically with increasing poverty for all race/ethnicity groups.

Conclusion.

There are differences in subsite-specific CRC incidence by poverty, but associations were moderated by race/ethnicity.