Rural and racial disparities in colorectal cancer incidence and mortality in South Carolina, 1996 – 2016

Abstract

Purpose: Colorectal cancer (CRC) is the third leading cause of cancer mortality among men and women in the United States and South Carolina (SC). Since SC has one of the highest proportions of Black (27.9%) and rural residents (33.7%), the purpose of this investigation was to describe the burden of CRC on racial disparities in rural populations.Methods: Count data from 2012 to 2016 were obtained from the state central cancer registry using an online data retrieval system. Rural-urban status was determined using Urban Influence Codes (1-2 = urban; 3-12 = rural). Chi-square tests were calculated to examine differences in CRC stage by rurality and race. Annual percent change and annual average percent change (AAPC) were calculated to examine trends in incidence and mortality rates across rural-urban and racial groups between 1996 and 2016.Results: Areas with high mortality-to-incidence ratios tended to be in rural counties. Furthermore, rural residents had higher proportions of distant stage CRC compared to urban residents, and Black populations had higher proportions of distant stage CRC compared to White populations (22.7% vs. 26.3% and 29.3% vs. 23.7%, respectively; P value < 0.05). From 1996 to 2016, Black and White urban-dwelling residents experienced a significant decline in incidence. Urban White, urban Black, and rural White populations experienced significant declines in mortality (AAPC = −2.6% vs −2.4% vs −1.6% vs −0.9%, respectively). Conclusions: Despite improvements in CRC screening in recent decades, focused evidenced-based interventions for lowering incidence and mortality among rural and Black populations in South Carolina are necessary. K E Y W O R D S colorectal cancer, health status disparity, race factors, rural health Colorectal cancer (CRC) is the third leading cause of cancer mortality among men and women in the United States with over 104,000 estimated new cases in 2020. 1 Additionally, the American Cancer Society estimates over 53,000 deaths will be due to CRC in 2020. Despite this high burden, CRC incidence and mortality rates have improved over time. CRC incidence has declined between 2.0% and 3.5% annually, 34

The Intersection of Race and Rurality and its Effect on Colorectal Cancer Survival

“…This work was not focused on CRC but it provides in-depth and valuable insight regarding the social determinants of health at play in these populations and how those determinants of health may work together to affect cancer outcomes. Adams et al 19 investigated trends in incidence and mortality of CRC across racial and rural-urban populations. Their study found CRC mortality decreased over time in all racial and geographic groups with the exception of the rural Black population.…”

Qualitative analysis of cancer care experiences among rural cancer survivors and caregivers

“…Facilities and services essential for cancer treatment, such as laboratories and radiation therapy, are also more sparse in rural areas 3 . Therefore, rural residents often need to travel long distances to obtain cancer screening, diagnosis, and treatment 2–8 . Rural patients' access to care is further aggravated by low socioeconomic status, lack of insurance coverage, 8 weather‐associated road conditions, and lack of public transportation 7 .…”

“…[2][3][4][5][6][7][8] Rural patients' access to care is further aggravated by low socioeconomic status, lack of insurance coverage, 8 weather-associated road conditions, and lack of public transportation. 7 These rural-urban differences lead to disparities in the utilization of cancer screening services as well as the use of adjuvant therapy. 8 Differential access and utilization of cancer-related services are important metrics due to their association with negative cancer outcomes.…”

“… 3 Therefore, rural residents often need to travel long distances to obtain cancer screening, diagnosis, and treatment. 2 , 3 , 4 , 5 , 6 , 7 , 8 Rural patients' access to care is further aggravated by low socioeconomic status, lack of insurance coverage, 8 weather‐associated road conditions, and lack of public transportation. 7 These rural‐urban differences lead to disparities in the utilization of cancer screening services as well as the use of adjuvant therapy.…”

Qualitative Analysis of Colorectal Cancer Screening in Rural Nebraska

“…Cancer services are underused by rural residents in the United States (US) [ 1 ]. Rural residents often need to travel long distances to obtain cancer screening, diagnostic services, and treatment, and weather-associated road conditions and lack of public transportation may further impede care [ 2 ]. Additionally, healthcare accessibility, especially specialized cancer care, is aggravated by low socioeconomic status and lack of health insurance [ 1 ].…”