Examining determinants of geographic variation in colorectal cancer mortality in North Carolina: A spatial analysis approach |
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Affiliation: | 1. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;2. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;1. Department of Pediatrics, Shanghai East Hospital, Shanghai East Hospital of Tongji University, 200120 Shanghai, China;2. Department of Pediatrics, Changzheng Hospital Affiliated to the SMMU, 200003 Shanghai, China;3. Department of Clinical Pharmacy, College of Pharmacy, China Pharmaceutical University, 211198 Nanjing, China;4. Department of Pediatrics, Zhabei District Central Hospital, 200070 Shanghai, China;1. Department of Urology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark;2. The Danish Clinical Registries (RKKP), Olaf Palmes Allé 15, 8200, Aarhus N, Denmark;3. Department of Public Health, Aarhus University, Bartholins Allé 2, Building 1260, 8000, Aarhus, Denmark;4. Diet, Genes and Environment, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark;5. Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark |
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Abstract: | PurposeA recent study using national data from 2000 to 2009 identified colorectal cancer (CRC) mortality “hotspots” in 11 counties of North Carolina (NC). In this study, we used more recent, state-specific data to investigate the county-level determinants of geographic variation in NC through a geospatial analytic approach.MethodUsing NC CRC mortality data from 2003 to 2013, we first conducted clustering analysis to confirm spatial dependence. Spatial economic models were then used to incorporate spatial structure to estimate the association between determinants and CRC mortality. We included county-level data on socio-demographic characteristics, access and quality of healthcare, behavioral risk factors (CRC screening, obesity, and cigarette smoking), and urbanicity. Due to correlation among screening, obesity and quality of healthcare, we combined these factors to form a cumulative risk group variable in the analysis.ResultsWe confirmed the existence of spatial dependence and identified clusters of elevated CRC mortality rates in NC counties. Using a spatial lag model, we found significant interaction effect between CRC risk groups and socioeconomic deprivation. Higher CRC mortality rates were also associated with rural counties with large towns compared to urban counties.ConclusionOur findings depicted a spatial diffusion process of CRC mortality rates across NC counties, demonstrated intertwined effects between SES deprivation and behavioral risks in shaping CRC mortality at area-level, and identified counties with high CRC mortality that were also deprived in multiple factors. These results suggest interventions to reduce geographic variation in CRC mortality should develop multifaceted strategies and work through shared resources in neighboring areas. |
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Keywords: | Keywords: Geographic variation Spatial regression Colorectal cancer mortality Spatial diffusion |
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