Geographic variation in colorectal cancer survival and the role of small-area socioeconomic deprivation: a multilevel survival analysis of the NIH-AARP Diet and Health Study Cohort
Authors
Lian, MinSchootman, Mario
Doubeni, Chyke A.
Park, Yikyung
Major, Jacqueline M.
Torres Stone, Rosalie A.
Laiyemo, Adeyinka O.
Hollenbeck, Albert R.
Graubard, Barry I.
Schatzkin, Arthur
UMass Chan Affiliations
Department of PsychiatryMeyers Primary Care Institute
Department of Family Medicine and Community Health
Document Type
Journal ArticlePublication Date
2011-08-11Keywords
AgedBayes Theorem
Cause of Death
Cohort Studies
Colorectal Neoplasms
Consumer Organizations
Female
Geography
*Health Status Disparities
Humans
Male
Middle Aged
National Institutes of Health (U.S.)
Poverty
Prospective Studies
Questionnaires
Retirement
Risk Factors
Socioeconomic Factors
Survival Analysis
Unemployment
United States
cohort studies
colorectal neoplasms
geography
multilevel analysis
residence characteristics
socioeconomic factors
survival
Community Health and Preventive Medicine
Digestive System Diseases
Investigative Techniques
Neoplasms
Pathological Conditions, Signs and Symptoms
Preventive Medicine
Primary Care
Metadata
Show full item recordAbstract
Adverse socioeconomic conditions, at both the individual and the neighborhood level, increase the risk of colorectal cancer (CRC) death, but little is known regarding whether CRC survival varies geographically and the extent to which area-level socioeconomic deprivation affects this geographic variation. Using data from the National Institutes of Health (NIH)-AARP Diet and Health Study, the authors examined geographic variation and the role of area-level socioeconomic deprivation in CRC survival. CRC cases (n = 7,024), identified during 1995-2003, were followed for their CRC-specific vital status through 2005 and overall vital status through 2006. Bayesian multilevel survival models showed that there was significant geographic variation in overall (variance = 0.2, 95% confidence interval (CI): 0.1, 0.2) and CRC-specific (variance = 0.3, 95% CI: 0.1, 0.4) risk of death. More socioeconomically deprived neighborhoods had a higher overall risk of death (most deprived quartile vs. least deprived: hazard ratio = 1.2, 95% CI: 1.1, 1.4) and a higher CRC-specific risk of death (most deprived quartile vs. least deprived: hazard ratio = 1.2, 95% CI: 1.1, 1.5). However, neighborhood socioeconomic deprivation did not account for the geographic variation in overall and CRC-specific risks of death. In future studies, investigators should evaluate other neighborhood characteristics to help explain geographic heterogeneity in CRC survival. Such research could facilitate interventions for reducing geographic disparity in CRC survival.Source
Am J Epidemiol. 2011 Oct 1;174(7):828-38. Epub 2011 Aug 11. Link to article on publisher's site
DOI
10.1093/aje/kwr162Permanent Link to this Item
http://hdl.handle.net/20.500.14038/30838PubMed ID
21836166Related Resources
ae974a485f413a2113503eed53cd6c53
10.1093/aje/kwr162