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Canadian Journal of Gastroenterology and Hepatology
Volume 28, Issue 4, Pages 191-197
Original Article

Geographical Variation and Factors Associated with Colorectal Cancer Mortality in a Universal Health Care System

Mahmoud Torabi,1 Christopher Green,1 Zoann Nugent,1,2,3 Salaheddin M Mahmud,1,3 Alain A Demers,1,3 Jane Griffith,1,3 and Harminder Singh1,2,4,5

1Department of Community Health Sciences, Winnipeg, Manitoba, Canada
2University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
3Department of Epidemiology and Cancer Registry, Winnipeg, Manitoba, Canada
4Department of Hematology and Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
5Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

Received 5 February 2014; Accepted 7 February 2014

Copyright © 2014 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


OBJECTIVE: To investigate the geographical variation and small geographical area level factors associated with colorectal cancer (CRC) mortality.

METHODS: Information regarding CRC mortality was obtained from the population-based Manitoba Cancer Registry, population counts were obtained from Manitoba’s universal health care plan Registry and characteristics of the area of residence were obtained from the 2001 Canadian census. Bayesian spatial Poisson mixed models were used to evaluate the geographical variation of CRC mortality and Poisson regression models for determining associations with CRC mortality. Time trends of CRC mortality according to income group were plotted using joinpoint regression.

RESULTS: The southeast (mortality rate ratio [MRR] 1.31 [95% CI 1.12 to 1.54) and southcentral (MRR 1.62 [95% CI 1.35 to 1.92]) regions of Manitoba had higher CRC mortality rates than suburban Winnipeg (Manitoba’s capital city). Between 1985 and 1996, CRC mortality did not vary according to household income; however, between 1997 and 2009, individuals residing in the highest-income areas were less likely to die from CRC (MRR 0.77 [95% CI 0.65 to 0.89]). Divergence in CRC mortality among individuals residing in different income areas increased over time, with rising CRC mortality observed in the lowest income areas and declining CRC mortality observed in the higher income areas.

CONCLUSIONS: Individuals residing in lower income neighbourhoods experienced rising CRC mortality despite residing in a jurisdiction with universal health care and should receive increased efforts to reduce CRC mortality. These findings should be of particular interest to the provincial CRC screening programs, which may be able to reduce the disparities in CRC mortality by reducing the disparities in CRC screening participation.