Distance to endoscopy services amplifies racial inequities in colorectal cancer mortality in Washington state

Ashley Edwards; Rachel Monroe; Ofer Amram; Anjali Kumar

doi:10.1016/j.amjsurg.2024.04.003

Distance to endoscopy services amplifies racial inequities in colorectal cancer mortality in Washington state

Am J Surg. 2024 Apr 18:S0002-9610(24)00198-3. doi: 10.1016/j.amjsurg.2024.04.003. Online ahead of print.

Authors

Ashley Edwards¹, Rachel Monroe², Ofer Amram³, Anjali Kumar⁴

Affiliations

¹ Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
² Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Providence Hood River Family Medicine Residency Program, Hood River, OR, USA.
³ Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Community Health and Spatial Epidemiology Lab, Washington State University, Spokane, WA, USA.
⁴ Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA. Electronic address: askumarmd@gmail.com.

PMID: 38670835
DOI: 10.1016/j.amjsurg.2024.04.003

Abstract

Background: This study evaluates relationships among race, access to endoscopy services, and colorectal cancer (CRC) mortality in Washington state (WA).

Methods: We overlayed the locations of ambulatory endoscopy services with place of residence at time of death, using Department of Health data (2011-2018). We compared CRC mortality data within and outside a 10 km buffer from services. We used linear regression to assess the impact of distance and race on age at death while adjusting for gender and education level.

Results: Age at death: median 72.9y vs. 68.2y for white vs. non-white (p < 0.001). The adjusted model showed that non-whites residing outside the buffer died 6.9y younger on average (p < 0.001). Non-whites residing inside the buffer died 5.2y younger on average (p < 0.001), and whites residing outside the buffer died 1.6y younger (p < 0.001). We used heatmaps to geolocate death density.

Conclusions: Results suggest that geographic access to endoscopy services disproportionately impacts non-whites in Washington. These data help identify communities which may benefit from improved access to alternative colorectal cancer screening methods.

Keywords: Colonoscopy; Colorectal cancer; Disparities in healthcare; Race; Rural health.