Colorectal cancer, socioeconomic distribution and behavior: A comparative analysis of urban and rural counties in the USA

Abstract

Background: Colorectal cancer (CRC) ranks second for all cancer related deaths among men and women together and third for either sex when considered separately. Disparities exist in CRC incidence and mortality between rural and urban counties in the USA. This study sought to explore socioeconomic and behavioral factors that may partly explain these observed differences. Methods: Using educational and income levels as measures of socioeconomic status (SES), and average alcohol consumption and smoking frequency as behavioral factors, data from the Behavioral Risk Factor Surveillance System (BRFSS) and the Surveillance, Epidemiology, and End Results (SEER) program were coupled for analysis. RESULTS: Results showed statistically significant inequalities for CRC incidence (t = 2.675, p = 0.009) and mortality (t = 2.328, p = 0.022), as well as socioeconomic (i.e., poverty; t = 4.864, p < 0.001) and behavioral (i.e., smoking; t = 2.777, p = 0.007) factors between selected rural and urban counties. Regression analysis for colorectal cancer incidence and mortality rates at the rural, urban, and national levels showed that smoking behavior was the strongest predictor, while relative impacts of alcohol consumption and SES were observed. Conclusion: Health policies aimed at reducing disparities between rural and urban populations in the USA must therefore adequately address SES and behavioral factors.