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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

Relationships between colorectal cancer characteristics and CRC screening resources in Mississippi’s Public Health Districts. Data listed in Table 1 were subjected to a common Spearman rank correlation analysis. Two associative trends were observed. There is a positive association (R = 0.649, P = 0.058) between self-reported CRC screening rates and the ratio of gastroenterologists per facilities offering colonoscopies (panela), and there is a comparable positive association (R = 0.649; P = 0.058) between colorectal cancer mortality rates and the number of residents per gastroenterologists (panelb)
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Fig5: Relationships between colorectal cancer characteristics and CRC screening resources in Mississippi’s Public Health Districts. Data listed in Table 1 were subjected to a common Spearman rank correlation analysis. Two associative trends were observed. There is a positive association (R = 0.649, P = 0.058) between self-reported CRC screening rates and the ratio of gastroenterologists per facilities offering colonoscopies (panela), and there is a comparable positive association (R = 0.649; P = 0.058) between colorectal cancer mortality rates and the number of residents per gastroenterologists (panelb)

Mentions: Correlation analyses were then performed to ascertain whether any of these CRC screening resources affected CRC characteristics of Mississippi’s nine Public Health Districts. Although these were not as strong as the correlations presented in Fig. 1, and although they did not meet the threshold value for statistical significance (P ≤ 0.05), two interesting trends were noted. As shown in Fig. 5 (panel a), there was a positive associative trend (r = 0.649, P = 0.058) between self-reported CRC screening rates and the ratio of gastroenterologists per facilities offering colonoscopies. Thus, PHDs with fewer gastroenterologists than colonoscopy facilities (hospitals and ambulatory surgical facilities combined) tended to report lower rates of colonoscopy/flexible sigmoidoscopy usage. Conversely, PHDs with more gastroenterologists than colonoscopy facilities tended to report higher CRC screening rates. In addition, there was a positive associative trend (R = 0.649, P = 0.058) between colorectal cancer mortality rates and the number of residents per gastroenterologists (Fig. 5 panel b). Thus, PHDs with the lowest per-capita number of gastroenterologists tended to have the highest CRC mortality rates, and those with the highest per-capita number of gastroenterologists tended to have the lowest CRC mortality rates.Fig. 5


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)

Relationships between colorectal cancer characteristics and CRC screening resources in Mississippi’s Public Health Districts. Data listed in Table 1 were subjected to a common Spearman rank correlation analysis. Two associative trends were observed. There is a positive association (R = 0.649, P = 0.058) between self-reported CRC screening rates and the ratio of gastroenterologists per facilities offering colonoscopies (panela), and there is a comparable positive association (R = 0.649; P = 0.058) between colorectal cancer mortality rates and the number of residents per gastroenterologists (panelb)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig5: Relationships between colorectal cancer characteristics and CRC screening resources in Mississippi’s Public Health Districts. Data listed in Table 1 were subjected to a common Spearman rank correlation analysis. Two associative trends were observed. There is a positive association (R = 0.649, P = 0.058) between self-reported CRC screening rates and the ratio of gastroenterologists per facilities offering colonoscopies (panela), and there is a comparable positive association (R = 0.649; P = 0.058) between colorectal cancer mortality rates and the number of residents per gastroenterologists (panelb)
Mentions: Correlation analyses were then performed to ascertain whether any of these CRC screening resources affected CRC characteristics of Mississippi’s nine Public Health Districts. Although these were not as strong as the correlations presented in Fig. 1, and although they did not meet the threshold value for statistical significance (P ≤ 0.05), two interesting trends were noted. As shown in Fig. 5 (panel a), there was a positive associative trend (r = 0.649, P = 0.058) between self-reported CRC screening rates and the ratio of gastroenterologists per facilities offering colonoscopies. Thus, PHDs with fewer gastroenterologists than colonoscopy facilities (hospitals and ambulatory surgical facilities combined) tended to report lower rates of colonoscopy/flexible sigmoidoscopy usage. Conversely, PHDs with more gastroenterologists than colonoscopy facilities tended to report higher CRC screening rates. In addition, there was a positive associative trend (R = 0.649, P = 0.058) between colorectal cancer mortality rates and the number of residents per gastroenterologists (Fig. 5 panel b). Thus, PHDs with the lowest per-capita number of gastroenterologists tended to have the highest CRC mortality rates, and those with the highest per-capita number of gastroenterologists tended to have the lowest CRC mortality rates.Fig. 5

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