Background: Racial and socioeconomic inequalities are thought to be major contributors to differences in health and disease outcome in the US. National data confirm lower rates of screening, more advanced disease and higher morbidity and mortality among the poor and ethnic/racial minorities. There is a need to understand the role of social factors, specifically race and SES, as determinants of cancer-related morbidity and mortality, and to identify their mechanism of action. Objectives: The primary objective of this study is to assess the unique effect of race and SES as determinants of differences in incidence, treatment and disease outcome between black and white with colorectal cancer (CRC). Another objective is to assess and compare the independent contribution of other factors such as age, gender, screening compliance, coexistent illnesses on CRC morbidity and survival among a subset of these CRC patients. Methods: This study will have two phases: 1) A retrospective phase will include a) assessment of incidence and mortality rates for CRC in the state of Alabama using data from the Alabama Statewide Tumor Registry (ASCR) for a period of 4 to 5 years; b) development of neighborhood measures of SES, based on 1990 census data and, c) matching of cancer cases with SES, based on area of residence. II) A formative phase during which individual interviews as well as medical records abstraction will be conducted on a randomly selected subset of CRC patients. This phase will gather individual-level socioeconomic and demographic data and information about co-morbidity at the time of diagnosis. Analyses will assess the association of contextual SES and ethnicity as well as that of individual SES and other factors on colorectal disparities. The proposed research is part of a 5-year plan of didactic work, fieldwork experiences and research training. This plan will provide the candidate needed training opportunities: a) to develop/enhance her skills and expertise in developing, conducting and evaluating sound and relevant clinical and community-based research in cancer control, particularly among special populations groups and; b) to complete her transition toward an independent and productive career in public health research and academia.
| Shipp, Michele P L; Desmond, Renee; Accortt, Neil et al. (2005) Population-based study of the geographic variation in colon cancer incidence in Alabama: relationship to socioeconomic status indicators and physician density. South Med J 98:1076-82 |
