County‐level colorectal cancer screening rates on colorectal cancer survival in the state of Georgia: Does county‐level rurality matter?

Abstract

PurposeInvestigating CRC screening rates and rurality at the county‐level may explain disparities in CRC survival in Georgia. Although a few studies examined the relationship of CRC screening rates, rurality, and/or CRC outcomes, they either used an ecological study design or focused on the larger population.MethodsWe conducted a retrospective analysis utilizing data from the 2004–2010 Surveillance, Epidemiology, and End Results Program. The 2013 United States Department of Agriculture rural–urban continuum codes and 2004–2010 National Cancer Institute small‐area estimates for screening behaviors were used to identify county‐level rurality and CRC screening rates. Kaplan–Meier method and Cox proportional hazard regression were performed.ResultsAmong 22,160 CRC patients, 5‐year CRC survival rates were lower among CRC patients living in low screening areas in comparison with intermediate/high areas (69.1% vs. 71.6% /71.3%; p‐value = 0.030). Patients living in rural high‐screening areas also had lower survival rates compared to non‐rural areas (68.2% vs. 71.8%; p‐value = 0.009). Our multivariable analysis demonstrated that patients living in intermediate (HR, 0.91; 95% CI, 0.85–0.98) and high‐screening (HR, 0.92; 95% CI, 0.85–0.99) areas were at 8%–9% reduced risk of CRC death. Further, non‐rural CRC patients living in intermediate and high CRC screening areas were 9% (HR, 0.91; 95% CI, 0.83–0.99) and 10% (HR, 0.90; 95% CI, 0.82–0.99) less likely to die from CRC.ConclusionsLower 5‐year survival rates were observed in low screening and rural high‐screening areas. Living in intermediate/high CRC screening areas was negatively associated with the risk of CRC death. Particularly, non‐rural patients living in intermediate/high‐screening areas were 8%–9% less likely to die from CRC. Targeted CRC screening resources should be prioritized for low screening and rural communities.