School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Cancer Causes Control. 2022 Apr;33(4):525-532. doi: 10.1007/s10552-021-01546-7. Epub 2022 Jan 7.
Currently, rural residents in the United States (US) experience a greater cancer burden for tobacco-related cancers and cancers that can be prevented by screening. We aim to characterize geographic determinants of colorectal cancer (CRC) incidence in Louisiana due to rural residence and other known geographic risk factors, area socioeconomic status (SES), and cultural region (Acadian or French-speaking).
Primary colorectal cancer diagnosed among adults 30 years and older in 2008-2017 were obtained from the Louisiana Tumor Registry. Population and social and economic data were obtained from US Census American Community Survey. Rural areas were defined using US Department of Agriculture 2010 rural-urban commuting area codes. Estimates of relative risk (RR) were obtained from multilevel binomial regression models of incidence.
The study population was 16.1% rural, 18.4% low SES, and 17.9% Acadian. Risk of CRC was greater among rural white residents (RR Women: 1.09(1.02-1.16), RR Men: 1.11(1.04-1.18)). Low SES was associated with increased CRC for all demographic groups, with excess risk ranging from 8% in Black men (RR: 1.08(1.01-1.16)) to 16% in white men (RR: 1.16(1.08-1.24)). Increased risk in the Acadian region was greatest for Black men (RR: 1.21(1.10-1.33)) and women (RR: 1.21(1.09-1.33)). Rural-urban disparities in CRC were no longer significant after controlling for SES and Acadian region.
SES remains a significant determinant of CRC disparities in Louisiana and may contribute to observed rural-urban disparities in the state. While the intersectionality of CRC risk factors is complex, we have confirmed a robust regional disparity for the Acadian region of Louisiana.
目前，美国农村居民面临着更大的与烟草相关的癌症和可通过筛查预防的癌症负担。我们旨在描述路易斯安那州因农村居住和其他已知地理风险因素、地区社会经济地位（SES）和文化区域（阿卡迪亚或说法语）而导致的结直肠癌（CRC）发病率的地理决定因素。
从路易斯安那州肿瘤登记处获得了 2008 年至 2017 年期间 30 岁及以上成年人的原发性结直肠癌诊断病例。人口和社会经济数据来自美国人口普查美国社区调查。农村地区使用美国农业部 2010 年城乡通勤区代码定义。使用发病率的多层二项式回归模型获得相对风险（RR）的估计值。
研究人群中 16.1%为农村人口，18.4%为 SES 较低，17.9%为阿卡迪亚人。农村白人居民的 CRC 风险较高（女性：RR1.09(1.02-1.16)，男性：RR1.11(1.04-1.18)）。SES 与所有人群的 CRC 风险增加有关，黑人男性的超额风险为 8%（RR：1.08(1.01-1.16)），白人男性的超额风险为 16%（RR：1.16(1.08-1.24)）。阿卡迪亚地区的风险增加对黑人男性（RR：1.21(1.10-1.33）和女性（RR：1.21(1.09-1.33））最大。在控制 SES 和阿卡迪亚地区后，CRC 的城乡差异不再显著。
SES 仍然是路易斯安那州 CRC 差异的重要决定因素，并且可能导致该州观察到的城乡差异。虽然 CRC 风险因素的交叉性很复杂，但我们已经证实了路易斯安那州阿卡迪亚地区的明显区域差异。
