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Unformatted text preview: ORIGINAL PAPER Trends in colorectal cancer incidence rates by age, race/ethnicity, and indices of access to medical care, 1995–2004 (United States) Yongping Hao Æ Ahmedin Jemal Æ Xingyou Zhang Æ Elizabeth M. Ward Received: 23 September 2008 / Accepted: 4 June 2009 / Published online: 19 June 2009 Ó Springer Science+Business Media B.V. 2009 Abstract Objective Colorectal cancer (CRC) incidence rates in the US decreased rapidly since 1998. This is largely thought to reflect increases in utilization of CRC screening through detection and removal of adenomatous polyps. However, the extent to which the decrease varies by age, race/eth- nicity, and differences in access to medical care is largely unknown. Methods Temporal trends in CRC incidence rates were examined from 1995 to 2004 by regression analysis according to age (50–64, C 65), race/ethnicity (whites, African Americans, and Hispanics), and categories of county-level indicators of access to care (poverty, primary care physician supply [PCP], uninsured rate [age 50–64], and metro/nonmetro) using incidence data from 19 cancer registries, covering about 53% of the US population. Changes in colorectal endoscopic screening and fecal occult blood stool test (FOBT) from 1995–1997 to 2002– 2004 for the same set of county-level indicators were also analyzed, using data from the Behavioral Risk Factor Surveillance System (BRFSS). Results Among whites, CRC incidence rates decreased significantly from 1998 through 2004 in age C 65, but not in age 50–64 in counties with high uninsured or poverty rates, fewer PCPs, or in nonmetro areas. Among African Americans or Hispanics, rates did not decrease in age 50–64 in general and age C 65 in counties with high poverty rates, low PCP supply, and nonmetro counties (African Americans). Colorectal endoscopic screening rates increased significantly among whites in both age groups, but not among Hispanics (aged 50–64 in general and aged C 65 residing in high poverty counties) or African Americans residing in counties with higher uninsured rates (age 50–64), low PCP supply, high poverty rates, and nonmetro counties (age C 65). FOBT rates remained unchanged during the study time period. Conclusions Our results suggest that individuals residing in poorer communities with lower access to medical care have not experienced the reduction in CRC incidence rates that have benefited more affluent communities; these dis- parities may be related to health care access barriers to colorectal endoscopic screening. Keywords Colorectal cancer incidence rates Á Colorectal endoscopic screening rates Á Fecal occult blood stool test (FOBT), Access to medical care Introduction Incidence rates from CRC have been decreasing rapidly in the US since 1998 based on data from the nine oldest SEER (Surveillance Epidemiology and End Results) registries, which cover about 10% of US population. This decrease followed a longer-term declining trend from 1985 to 1995, interrupted by a 3-year stable trend in 1995–1998. Theinterrupted by a 3-year stable trend in 1995–1998....
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This note was uploaded on 05/20/2010 for the course BIO 25 taught by Professor Bryanngo during the Winter '10 term at UC Irvine.
- Winter '10