Neighborhood disadvantage and racial disparities in colorectal cancer incidence: a population-based study in Louisiana

Denise M Danos; Tekeda F Ferguson; Neal R Simonsen; Claudia Leonardi; Qingzhao Yu; Xiao-Cheng Wu; Richard A Scribner

doi:10.1016/j.annepidem.2018.02.004

Neighborhood disadvantage and racial disparities in colorectal cancer incidence: a population-based study in Louisiana

Ann Epidemiol. 2018 May;28(5):316-321.e2. doi: 10.1016/j.annepidem.2018.02.004. Epub 2018 Mar 22.

Authors

Denise M Danos¹, Tekeda F Ferguson², Neal R Simonsen¹, Claudia Leonardi³, Qingzhao Yu⁴, Xiao-Cheng Wu⁵, Richard A Scribner⁶

Affiliations

¹ Stanley S. Scott Cancer Center, Louisiana State University Health-New Orleans, School of Medicine, New Orleans, LA.
² Stanley S. Scott Cancer Center, Louisiana State University Health-New Orleans, School of Medicine, New Orleans, LA; Department of Epidemiology, Louisiana State University Health-New Orleans, School of Public Health, New Orleans, LA. Electronic address: tferg4@lsuhsc.edu.
³ Stanley S. Scott Cancer Center, Louisiana State University Health-New Orleans, School of Medicine, New Orleans, LA; Department of Community and Behavioral Health, Louisiana State University Health-New Orleans, School of Public Health, New Orleans, LA.
⁴ Stanley S. Scott Cancer Center, Louisiana State University Health-New Orleans, School of Medicine, New Orleans, LA; Department of Biostatistics, Louisiana State University Health-New Orleans, School of Public Health, New Orleans, LA.
⁵ Department of Epidemiology, Louisiana State University Health-New Orleans, School of Public Health, New Orleans, LA; Louisiana Tumor Registry, Louisiana State University Health-New Orleans, School of Public Health, New Orleans, LA.
⁶ Stanley S. Scott Cancer Center, Louisiana State University Health-New Orleans, School of Medicine, New Orleans, LA; Department of Epidemiology, Louisiana State University Health-New Orleans, School of Public Health, New Orleans, LA.

Abstract

Purpose: Colorectal cancer (CRC) continues to demonstrate racial disparities in incidence and survival in the United States. This study investigates the role of neighborhood concentrated disadvantage in racial disparities in CRC incidence in Louisiana.

Methods: Louisiana Tumor Registry and U.S. Census data were used to assess the incidence of CRC diagnosed in individuals 35 years and older between 2008 and 2012. Neighborhood concentrated disadvantage index (CDI) was calculated based on the PhenX Toolkit protocol. The incidence of CRC was modeled using multilevel binomial regression with individuals nested within neighborhoods.

Results: Our study included 10,198 cases of CRC. Adjusting for age and sex, CRC risk was 28% higher for blacks than whites (risk ratio [RR] = 1.28; 95% confidence interval [CI] = 1.22-1.33). One SD increase in CDI was associated with 14% increase in risk for whites (RR = 1.14; 95% CI = 1.10-1.18) and 5% increase for blacks (RR = 1.05; 95% CI = 1.02-1.09). After controlling for differential effects of CDI by race, racial disparities were not observed in disadvantaged areas.

Conclusion: CRC incidence increased with neighborhood disadvantage and racial disparities diminished with mounting disadvantage. Our results suggest additional dimensions to racial disparities in CRC outside of neighborhood disadvantage that warrants further research.

Keywords: Colorectal cancer; Concentrated disadvantage; Disparities; Multilevel modeling; Social epidemiology.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Colorectal Neoplasms / epidemiology*
Colorectal Neoplasms / ethnology
Female
Health Status Disparities*
Healthcare Disparities / ethnology
Healthcare Disparities / statistics & numerical data*
Humans
Incidence
Louisiana / epidemiology
Male
Middle Aged
Residence Characteristics*
Social Determinants of Health*
Socioeconomic Factors

Abstract

Publication types

MeSH terms

Grants and funding