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The impact of preventive screening resource distribution on geographic and population-based disparities in colorectal cancer in Mississippi.

Faruque FS, Zhang X, Nichols EN, Bradley DL, Reeves-Darby R, Reeves-Darby V, Duhé RJ - BMC Res Notes (2015)

Bottom Line: Significant population-based and geographic disparities in CRC screening behaviors and CRC outcomes exist in Mississippi.The effects of CRC screening resources are related to CRC screening behaviors and outcomes at a regional level, whereas at the county level, socioeconomic factors are more strongly associated with CRC outcomes.Thus, effective control of CRC in rural states with high poverty levels requires both adequate preventive CRC screening capacity and a strategy to address fundamental causes of health care disparities.

View Article: PubMed Central - PubMed

Affiliation: GIS and Remote Sensing Program, University of Mississippi Medical Center, Jackson, MS, 39216-4505, USA. ffaruque@umc.edu.

ABSTRACT

Background: The state of Mississippi has the highest colorectal cancer (CRC) mortality rate in the USA. The geographic distribution of CRC screening resources and geographic- and population-based CRC characteristics in Mississippi are investigated to reveal the geographic disparity in CRC screening.

Methods: The primary practice sites of licensed gastroenterologists and the addresses of licensed medical facilities offering on-site colonoscopies were verified via telephone surveys, then these CRC screening resource data were geocoded and analyzed using Geographic Information Systems. Correlation analyses were performed to detect the strength of associations between CRC screening resources, CRC screening behavior and CRC outcome data.

Results: Age-adjusted colorectal cancer incidence rates, mortality rates, mortality-to-incidence ratios, and self-reported endoscopic screening rates from the years 2006 through 2010 were significantly different for Black and White Mississippians; Blacks fared worse than Whites in all categories throughout all nine Public Health Districts. CRC screening rates were negatively correlated with CRC incidence rates and CRC mortality rates. The availability of gastroenterologists varied tremendously throughout the state; regions with the poorest CRC outcomes tended to be underserved by gastroenterologists.

Conclusions: Significant population-based and geographic disparities in CRC screening behaviors and CRC outcomes exist in Mississippi. The effects of CRC screening resources are related to CRC screening behaviors and outcomes at a regional level, whereas at the county level, socioeconomic factors are more strongly associated with CRC outcomes. Thus, effective control of CRC in rural states with high poverty levels requires both adequate preventive CRC screening capacity and a strategy to address fundamental causes of health care disparities.

No MeSH data available.


Related in: MedlinePlus

Map of colorectal cancer screening resources in Mississippi. As described in the “Methods ”, telephone survey instruments were developed to identify the 26 ambulatory surgical facilities (red dots) offering on-site colonoscopies in Mississippi. The hospitals and ambulatory surgical facilities are mapped by ZIP code
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Fig3: Map of colorectal cancer screening resources in Mississippi. As described in the “Methods ”, telephone survey instruments were developed to identify the 26 ambulatory surgical facilities (red dots) offering on-site colonoscopies in Mississippi. The hospitals and ambulatory surgical facilities are mapped by ZIP code

Mentions: An extremely broad range of endoscopic CRC screening rates were shown in Fig. 1, from a low of 40.4 % reported by Black Mississippians in Public Health District 3 to a high of 64.2 % reported by White Mississippians in Public Health District 5. The geographic distribution of endoscopic resources might contribute to such disparate results. While stool-based screens such as Fecal Immunohistochemical Tests (FIT) or high-sensitivity Fecal Occult Blood Tests (FOBT) are important early-detection screening methods, these resources are available through federally-qualified health centers, community health centers and primary care providers which are nearly ubiquitous throughout Mississippi, and are therefore unsuitable for geospatial analysis using the current study design. However, the availability of facilities to provide follow-up colonoscopy to confirm positive FOBT or FIT test results would be expected to affect the regional public health impact of these early-detection screens. Unlike mammography resources, which can be easily located via the US Food and Drug Administration’s Mammography Facility Database (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMQSA/mqsa.cfm), no database currently provides a complete listing of sites which offer colonoscopies in Mississippi. The Bureau of Health Facilities Licensure and Certification of the Mississippi State Department of Health maintains a listing of all licensed health facilities in the state, and only two categories of health facilities (Hospitals and Ambulatory Surgical Facilities) are authorized to offer colonoscopies. Using the January 2013 Directory of Health Facilities as a primary data source, a telephone survey was conducted to determine which hospitals and ambulatory surgical facilities offer on-site colonoscopies and to verify the street addresses of these facilities. Figure 2 reveals the location of all hospitals which offer on-site colonoscopies (blue dots), as well as those hospitals which do not offer on-site colonoscopies (gray dots). Figure 3 shows the location of all ambulatory surgical facilities which offer on-site colonoscopies (red dots). Because it has been suggested that the accuracy and efficacy of colonoscopies performed by gastroenterologist endoscopists may be superior to those performed by non-gastroenterologist endoscopists [29, 30], the primary practice sites of gastroenterologists throughout Mississippi were also determined. Using a Roster of Licensed Physicians purchased from the Mississippi State Board of Medical Licensure, a telephone survey was conducted of all 178 physicians licensed in the specialty of gastroenterology as of July, 2013. Of these licensed gastroenterologists, 104 regularly practiced in Mississippi (defined as “practicing within Mississippi at least once each week, excluding vacation or holidays”), and the street addresses of their primary Mississippi practice sites were verified. These sites are shown (green dots) in Fig. 4; it should be noted that some gastroenterologists provide service at secondary practice sites, but secondary practice site data were not collected. At the time of the survey, only one Mississippi-licensed, out-of-state gastroenterologist regularly practiced in Mississippi; none of the other 66 Mississippi-licensed, out-of-state gastroenterologists did so. Four of the Mississippi-domiciled gastroenterologists were retired from practice; four others could not be contacted and their current telephone numbers could not be found, thus the gastroenterologist survey data were 97.7 % complete.Fig. 2


The impact of preventive screening resource distribution on geographic and population-based disparities in colorectal cancer in Mississippi.

Faruque FS, Zhang X, Nichols EN, Bradley DL, Reeves-Darby R, Reeves-Darby V, Duhé RJ - BMC Res Notes (2015)

Map of colorectal cancer screening resources in Mississippi. As described in the “Methods ”, telephone survey instruments were developed to identify the 26 ambulatory surgical facilities (red dots) offering on-site colonoscopies in Mississippi. The hospitals and ambulatory surgical facilities are mapped by ZIP code
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4562344&req=5

Fig3: Map of colorectal cancer screening resources in Mississippi. As described in the “Methods ”, telephone survey instruments were developed to identify the 26 ambulatory surgical facilities (red dots) offering on-site colonoscopies in Mississippi. The hospitals and ambulatory surgical facilities are mapped by ZIP code
Mentions: An extremely broad range of endoscopic CRC screening rates were shown in Fig. 1, from a low of 40.4 % reported by Black Mississippians in Public Health District 3 to a high of 64.2 % reported by White Mississippians in Public Health District 5. The geographic distribution of endoscopic resources might contribute to such disparate results. While stool-based screens such as Fecal Immunohistochemical Tests (FIT) or high-sensitivity Fecal Occult Blood Tests (FOBT) are important early-detection screening methods, these resources are available through federally-qualified health centers, community health centers and primary care providers which are nearly ubiquitous throughout Mississippi, and are therefore unsuitable for geospatial analysis using the current study design. However, the availability of facilities to provide follow-up colonoscopy to confirm positive FOBT or FIT test results would be expected to affect the regional public health impact of these early-detection screens. Unlike mammography resources, which can be easily located via the US Food and Drug Administration’s Mammography Facility Database (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMQSA/mqsa.cfm), no database currently provides a complete listing of sites which offer colonoscopies in Mississippi. The Bureau of Health Facilities Licensure and Certification of the Mississippi State Department of Health maintains a listing of all licensed health facilities in the state, and only two categories of health facilities (Hospitals and Ambulatory Surgical Facilities) are authorized to offer colonoscopies. Using the January 2013 Directory of Health Facilities as a primary data source, a telephone survey was conducted to determine which hospitals and ambulatory surgical facilities offer on-site colonoscopies and to verify the street addresses of these facilities. Figure 2 reveals the location of all hospitals which offer on-site colonoscopies (blue dots), as well as those hospitals which do not offer on-site colonoscopies (gray dots). Figure 3 shows the location of all ambulatory surgical facilities which offer on-site colonoscopies (red dots). Because it has been suggested that the accuracy and efficacy of colonoscopies performed by gastroenterologist endoscopists may be superior to those performed by non-gastroenterologist endoscopists [29, 30], the primary practice sites of gastroenterologists throughout Mississippi were also determined. Using a Roster of Licensed Physicians purchased from the Mississippi State Board of Medical Licensure, a telephone survey was conducted of all 178 physicians licensed in the specialty of gastroenterology as of July, 2013. Of these licensed gastroenterologists, 104 regularly practiced in Mississippi (defined as “practicing within Mississippi at least once each week, excluding vacation or holidays”), and the street addresses of their primary Mississippi practice sites were verified. These sites are shown (green dots) in Fig. 4; it should be noted that some gastroenterologists provide service at secondary practice sites, but secondary practice site data were not collected. At the time of the survey, only one Mississippi-licensed, out-of-state gastroenterologist regularly practiced in Mississippi; none of the other 66 Mississippi-licensed, out-of-state gastroenterologists did so. Four of the Mississippi-domiciled gastroenterologists were retired from practice; four others could not be contacted and their current telephone numbers could not be found, thus the gastroenterologist survey data were 97.7 % complete.Fig. 2

Bottom Line: Significant population-based and geographic disparities in CRC screening behaviors and CRC outcomes exist in Mississippi.The effects of CRC screening resources are related to CRC screening behaviors and outcomes at a regional level, whereas at the county level, socioeconomic factors are more strongly associated with CRC outcomes.Thus, effective control of CRC in rural states with high poverty levels requires both adequate preventive CRC screening capacity and a strategy to address fundamental causes of health care disparities.

View Article: PubMed Central - PubMed

Affiliation: GIS and Remote Sensing Program, University of Mississippi Medical Center, Jackson, MS, 39216-4505, USA. ffaruque@umc.edu.

ABSTRACT

Background: The state of Mississippi has the highest colorectal cancer (CRC) mortality rate in the USA. The geographic distribution of CRC screening resources and geographic- and population-based CRC characteristics in Mississippi are investigated to reveal the geographic disparity in CRC screening.

Methods: The primary practice sites of licensed gastroenterologists and the addresses of licensed medical facilities offering on-site colonoscopies were verified via telephone surveys, then these CRC screening resource data were geocoded and analyzed using Geographic Information Systems. Correlation analyses were performed to detect the strength of associations between CRC screening resources, CRC screening behavior and CRC outcome data.

Results: Age-adjusted colorectal cancer incidence rates, mortality rates, mortality-to-incidence ratios, and self-reported endoscopic screening rates from the years 2006 through 2010 were significantly different for Black and White Mississippians; Blacks fared worse than Whites in all categories throughout all nine Public Health Districts. CRC screening rates were negatively correlated with CRC incidence rates and CRC mortality rates. The availability of gastroenterologists varied tremendously throughout the state; regions with the poorest CRC outcomes tended to be underserved by gastroenterologists.

Conclusions: Significant population-based and geographic disparities in CRC screening behaviors and CRC outcomes exist in Mississippi. The effects of CRC screening resources are related to CRC screening behaviors and outcomes at a regional level, whereas at the county level, socioeconomic factors are more strongly associated with CRC outcomes. Thus, effective control of CRC in rural states with high poverty levels requires both adequate preventive CRC screening capacity and a strategy to address fundamental causes of health care disparities.

No MeSH data available.


Related in: MedlinePlus