Colorectal cancer (CRC) is the fourth most common cancer in the United States and the second leading cause of cancer deaths. Despite declines in CRC incidence rates, survival following diagnosis has improved only modestly over the past few decades. Even though environmental contexts play an important role in health, disease, and behavior, most studies about CRC survival have largely ignored the geographic variation and importance of area-level socioeconomic conditions that have been associated with CRC screening, CRC stage at diagnosis, and with the survival of many other cancers. CRC patients who live in areas with worse socioeconomic conditions have decreased survival than those who live under more affluent conditions;however, the mechanisms by which these area-level factors exert their influence on CRC survival remain unclear. This amended application of the proposed population-based, prospective study has three specific aims.
Aim 1) Determine the extent of the geographic variation of CRC survival across the United States based on small geographic areas at the sub-county (census-tract) level using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data for over 100,000 men and women aged 66 or older diagnosed with CRC.
Aim 2) Determine the extent to which lower CRC survival can be explained by higher area socioeconomic deprivation among persons age 66 and older.
Aim 3) Identify potential mediating pathways by which higher area socioeconomic deprivation is associated with lower CRC survival among persons age 66 and older, namely a) patient characteristics, b) physician and hospital characteristics, c) tumor characteristics, d) type of treatment received, and e) surveillance for CRC after diagnosis to detect recurrence and metastases. A multilevel spatial model will be developed to address the specific aims of the proposed study. We will use the following existing data sources: 1) 1992-2005 data from NCI's SEER program (survival, patient characteristics, type of treatment, tumor characteristics);2) 1991-2005 Medicare data (patient characteristics, type of treatment, surveillance after diagnosis) which is linked to the SEER data;3) 1991-2005 data from the Provider of Services File (hospital and physician characteristics), 4) 1990-2005 census data (area deprivation measures), and 5) Medicare Current Beneficiary Survey data. Advanced Bayesian spatial analyses of CRC survival will be performed and a geographic information system will be used to display the results. Our study will increase understanding of and identify important mechanisms of the role of area-level socioeconomic deprivation on CRC survival. In addition, this study will help provide opportunities for targeting specific geographic areas to allocate resources and interventions locally to improve CRC survival using evidence- based approaches, thereby reducing health disparities associated with living in socioeconomically deprived areas.

Public Health Relevance

Colorectal cancer is the second leading cause of cancer deaths. To reduce geographic disparities in survival following colorectal cancer and to develop and implement interventions that can be targeted locally, it is imperative to identify reasons for lower-than-expected survival.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA137750-05
Application #
8444701
Study Section
Community Influences on Health Behavior (CIHB)
Program Officer
Elena, Joanne W
Project Start
2009-05-01
Project End
2015-02-28
Budget Start
2013-03-01
Budget End
2014-02-28
Support Year
5
Fiscal Year
2013
Total Cost
$269,021
Indirect Cost
$92,034
Name
Washington University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
068552207
City
Saint Louis
State
MO
Country
United States
Zip Code
63130
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Schootman, Mario; Homan, Sherri; Weaver, Kathryn E et al. (2013) The health and welfare of rural and urban cancer survivors in Missouri. Prev Chronic Dis 10:E152
Chien, Lung-Chang; Schootman, Mario; Pruitt, Sandi L (2013) The modifying effect of patient location on stage-specific survival following colorectal cancer using geosurvival models. Cancer Causes Control 24:473-84
Doubeni, Chyke A; Schootman, Mario; Major, Jacqueline M et al. (2012) Health status, neighborhood socioeconomic context, and premature mortality in the United States: The National Institutes of Health-AARP Diet and Health Study. Am J Public Health 102:680-8
Lian, Min; Schootman, Mario; Doubeni, Chyke A et al. (2011) 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. Am J Epidemiol 174:828-38
Major, Jacqueline M; Cross, Amanda J; Doubeni, Chyke A et al. (2011) Socioeconomic deprivation impact on meat intake and mortality: NIH-AARP Diet and Health Study. Cancer Causes Control 22:1699-707

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