Colorectal carcinoma mortality among Appalachian men and women, 1969–1999

Authors

  • Lori R. Armstrong Ph.D.,

    Corresponding author
    1. Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
    • Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Mail Stop E-10, 1600 Clifton Road, Atlanta, GA 30333
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    • Fax: (404) 639-8117

  • Trevor Thompson B.S.,

    1. Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • H. Irene Hall Ph.D.,

    1. Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Steven S. Coughlin Ph.D.,

    1. Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Brooke Steele D.O.,

    1. Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Joe D. Rogers B.S.

    1. Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • The views expressed herein do not necessarily reflect the opinions of the Centers for Disease Control or the U.S. Government.

  • This article is a U.S. Government work and, as such, is in the public domain in the United States of America.

Abstract

BACKGROUND

Colorectal carcinoma screening can reduce mortality, but residents of poor or medically underserved areas may face barriers to screening. The current study assessed colorectal carcinoma mortality in Appalachia, a historically underserved area, from 1969 to 1999.

METHODS

All counties within the 13-state Appalachian region, which stretches from southern New York to northern Mississippi, were used to calculate annual death rates for the 31-year period. Joinpoint regression analysis was used to examine trends by age and race for the Appalachian region and the remainder of the United States. Five-year rates for 1995–1999 age-adjusted to the 2000 U.S. standard population were calculated by race and age group for the Appalachian region and elsewhere in the United States.

RESULTS

Trend analysis showed that colorectal carcinoma death rates among both racial and gender groups studied had declined in recent years. Despite this, the rates for white males and white females were still significantly higher in Appalachia than in the rest of the country at the end of the study period, 1999. Five-year colorectal carcinoma death rates among white males (ages < 50, 50–59, and 70–79 years) and white females (ages < 50, 50–59, 70–79, ≥ 80 years) were significantly higher in Appalachia than elsewhere in the United States, whereas rates among black females 60–69 and 70–79 years old were significantly lower in Appalachia.

CONCLUSIONS

The Appalachian region may benefit from targeted prevention efforts to eliminate disparities in the colorectal carcinoma death rates among subgroups. Further studies are needed to determine whether the higher death rates in specific Appalachian subgroups are related to a higher incidence of the disease, the cancer being at a later stage at diagnosis, poorer treatment, or other factors. Cancer 2004. Published 2004 by the American Cancer Society.

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