What You Need to Know: Lack of education, regardless of race or ethnicity, is the most important factor linked to disparities in mortality rates from colorectal cancer in the United States.
Background: It has long been known that there are disparities in mortality rates from colorectal cancer (CRC) between educated white and uneducated black populations in the United States. The study, led by Ahmedin Jemal, PhD, from the American Cancer Society in Atlanta, looked at the rate of death from CRC in people younger than 65 years (i.e., premature death) in each of the 50 states from 2008 to 2010. The researchers classified CRC patients 25 to 64 years of age by level of education (12 years or fewer, 13 to 15 years, and 16 years or more), race/ethnicity, and state.
They found there were significantly more premature CRC deaths in states with the lowest education levels than in those with higher levels. In fact, rates of premature death decreased with increased years of education, regardless of race or ethnicity.
- In the white population, Delaware had the fewest premature CRC deaths, but even in that state, the rate was 15% higher in the least-educated than in the most-educated people (rate ratio [RR], 1.15; 95% confidence interval [CI], 0.66 – 2.01). New Mexico had the most premature CRC deaths; the rate was 3-fold higher in the least-educated than in the most educated people (RR, 3.18; 95% CI, 2.01 – 5.05).
- In the black population, rate ratios ranged from 0.84 (95% CI, 0.54 – 1.30) in Mississippi to 2.41 (95% CI, 1.62 – 3.59) in Virginia. New York had the lowest death rate (12.9%) among those with the lowest level of education.
- Blaise Polite, MD, MPP of the University of Chicago expressed this view in an editorial: “The major finding from this study…remains unaltered: If you are black or have low educational attainment, where you live in the United States determines how likely you are to die as a result of colorectal cancer. That is an experiment that has to end in the 21st-century United States.”
My Take: We should be embarrassed. Between 2008 and 2010, more than 23,000 deaths from colon cancer, 50% of the total, could have been prevented if all states had colon cancer equal to the five states with the lowest rates for the most educated whites. An equally important point is the variation among the states; 69% of deaths could have been prevented in Mississippi, compared with only 29% in Utah. While lifestyle factors no doubt contribute to disparities, access to colonoscopy is a key component to reducing your chance of dying from colorectal cancer.
An author of the study adds: “Screening is recommended for people 50 to 75 years. In those with 12 years or less of education, only 40% get screened, compared with 70% of those with a college-level education,” he explained. Even worse, “in the uninsured population, it is only 19%. That is ridiculously low, and highlights the importance of access to care.”
I’m Dr. Michael Hunter.
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- J Clin Oncol. Published online January 20, 2015. Editorial