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Journal of Cancer Epidemiology
Volume 2014, Article ID 823484, 12 pages
Research Article

Associations of Census-Tract Poverty with Subsite-Specific Colorectal Cancer Incidence Rates and Stage of Disease at Diagnosis in the United States

1Department of Epidemiology, Rutgers School of Public Health and Rutgers Cancer Institute of New Jersey, 683 Hoes Lane West, Piscataway, NJ 08854, USA
2North American Association of Central Cancer Registries, 2121 West White Oaks Drive, Suite B, Springfield, IL 62704, USA
3Department of Geography, University of Utah, 260 South Central Campus Drive Room 270, Salt Lake City, UT 84112-9155, USA
4Cancer Data Registry of Idaho, 615 North 7th Street, P.O. Box 1278, Boise, ID 83701, USA
5Department of Health Services Research and Administration, University of Nebraska Medical Center, College of Public Health, Nebraska Medical Center, Omaha, NE 68198-4350, USA
6Department of Epidemiology and Biostatistics, School of Public Health, University of Albany, State University of New York, Albany, One University Place, Rensselaer, NY 12144, USA

Received 24 March 2014; Revised 16 June 2014; Accepted 23 June 2014; Published 3 August 2014

Academic Editor: P. Vineis

Copyright © 2014 Kevin A. Henry et al. 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.


Background. It remains unclear whether neighborhood poverty contributes to differences in subsite-specific colorectal cancer (CRC) incidence. We examined associations between census-tract poverty and CRC incidence and stage by anatomic subsite and race/ethnicity. Methods. CRC cases diagnosed between 2005 and 2009 from 15 states and Los Angeles County () were assigned to 1 of 4 groups based on census-tract poverty. Age-adjusted and stage-specific CRC incidence rates (IRs) and incidence rate ratios (IRRs) were calculated. Analyses were stratified by subsite (proximal, distal, and rectum), sex, race/ethnicity, and poverty. Results. Compared to the lowest poverty areas, CRC IRs were significantly higher in the most impoverished areas for men (IRR = 1.14 95% CI 1.12–1.17) and women (IRR = 1.06 95% CI 1.05–1.08). Rate differences between high and low poverty were strongest for distal colon (male IRR = 1.24 95% CI 1.20–1.28; female IRR = 1.14 95% CI 1.10–1.18) and weakest for proximal colon. These rate differences were significant for non-Hispanic whites and blacks and for Asian/Pacific Islander men. Inverse associations between poverty and IRs of all CRC and proximal colon were found for Hispanics. Late-to-early stage CRC IRRs increased monotonically with increasing poverty for all race/ethnicity groups. Conclusion. There are differences in subsite-specific CRC incidence by poverty, but associations were moderated by race/ethnicity.