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Cancer Epidemiol Biomarkers Prev. 2012 Oct;21(10):1814-22. doi: 10.1158/1055-9965.EPI-12-0659. Epub 2012 Aug 21.

Examining the association between socioeconomic status and invasive colorectal cancer incidence and mortality in California.

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  • 1Epidemiology Program, University of Hawai'i Cancer Center, University of Hawai'i, Honolulu, Hawaii 96813, USA.

Abstract

BACKGROUND:

Colorectal cancer (CRC) incidence and mortality rates vary across race/ethnicity. Socioeconomic status (SES) also influences CRC rates; however, these associations might be inconsistent across racial/ethnic groups and tumor subsite. We examined associations between area-level SES and CRC incidence and mortality in a population-based registry study of non-Hispanic Whites, African Americans, Hispanics, and Asians/Pacific Islanders from California.

METHODS:

Data on 52,608 incident CRC cases (1998-2002) and 14,515 CRC deaths (1999-2001) aged ≥50 years were obtained from the California Cancer Registry. Based on 2000 U.S. Census data, each cancer case and death was assigned a multidimensional census tract-level SES index. SES-specific quintiles of CRC incidence and mortality rates, incidence rate ratios (IRR) and mortality rate ratios, and 95% confidence intervals (CI) were estimated. Analyses were stratified by anatomical site, including left- versus right-sided tumors, race/ethnicity, and stage of disease.

RESULTS:

Overall CRC incidence and SES did not show a clear association, yet patterns of associations varied across tumor subsite and race/ethnicity. Positive associations between SES and CRC incidence were found in Hispanics [SES Q5 v. Q1: IRR = 1.54, CI = 1.39-1.69], irrespective of the subsite. For Whites [SES Q5 v. Q1: IRR = 0.80, CI = 0.77-0.83], and African Americans [SES Q5 v. Q1: IRR = 0.83, CI = 0.70-0.97] inverse associations were observed, predominantly for left-sided tumors. Mortality rates declined with increasing SES in Whites, whereas in Hispanics mortality rates significantly increased with SES.

CONCLUSIONS:

Our findings show that SES differences in CRC incidence and mortality vary considerably across anatomical subsite and race/ethnicity.

IMPACT:

Studies combining area- and individual-level SES information are warranted.

2012 AACR

PMID:
22911333
[PubMed - indexed for MEDLINE]
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