E. Benzer1, S. Tolefree1, C. DeRoche2, Z. Wu1, J. Mitchem1 1University Of Missouri,Department Of Surgery,Columbia, MO, USA 2University Of Missouri,Medical Research Office,Columbia, MO, USA
Introduction:
Colorectal cancer is the second leading cancer killer in the US. Screening significantly decreases the death rate from colorectal cancer, which has led to standard screening recommendations from multiple professional and government organizations. Despite this well-established data, adherence to colorectal cancer screening is poor. One reason for this may be access to care, as adherence to colorectal screening has previously been shown to be worse in rural populations. We used a population based data set combined with state level data on rurality to test the effect of rurality on screening and death rate from colorectal cancer.
Methods:
Publicly accessible data was downloaded from the American Cancer Society website compiled from the Center for Disease Control regarding colorectal cancer death rate average from 2010-2014 and Behavioral Risk Factor Surveillance System regarding colorectal cancer screening from 2014. Data regarding rural and urban populations, race, and socioeconomic status was downloaded from the US Census website. Data analysis was performed using SPSS.
Results:
The median percent of population residing in rural and urban areas in each state was 25.8% (0-61.3) and 73.8% (38.6-100), respectively. Median percent of patients screened was 67.6% (58-76), and the median death rate (per 100,000) from colorectal cancer per state was 14.6 (11.3-19.4). To establish that screening correlates with decreased death from colorectal cancer, each state’s percent screened was compared with death rate from colorectal cancer. This demonstrated significant negative correlation (-0.500, p< 0.001). Each state’s percent of population living in rural areas was then compared with death rate from colorectal cancer. This demonstrated a significant positive correlation (0.43, p= 0.002). To test our hypothesis, we then compared percent rural population with screening rate. We found no correlation between rural population and screening rate (-0.153, p=0.29). There was no difference between males or females. We then performed multivariate linear regression to factors associated with death rate from colorectal cancer. After this analysis, percent rural, percent African-American, and percent screened remained significant (p<0.05).
Conclusion:
State level data from the Behavioral Risk Factor Surveillance System, Center for Disease Control, and the US Census were used to determine whether increased rural population correlates with colorectal cancer death and screening. Both screening rate and state rurality correlate significantly with death rate from colorectal cancer; however, screening and rurality did not correlate. Based on this result, future interventions aimed at rural populations should focus not only on screening, but also what to do after screening results are obtained. Further analysis is warranted to delve deeper into this issue to improve outcomes from colorectal cancer in rural populations.