Description of the Spatial Heterogeneity in Colorectal Cancer (CRC) Mortality by Race across Georgia and an Investigation of the Association between Area-Level Factors and the Disparity Público
Nguyen, Nancy (Spring 2022)
Abstract
Background: In the US and Georgia, colorectal cancer (CRC) is the 3rd leading cause of cancer death in both men and women (1, 2). Even as mortality rates decline each year, race disparities in CRC mortality persist. Many studies have investigated individual and area-level SES on colorectal cancer mortality and the racial disparity however few have investigated the relationship through a spatial lens. This analysis examines the variation in CRC mortality across counties in Georgia by race and area-level factors that may be drivers in the heterogeneity.
Methods: 2,622 colorectal cancer deaths obtained from the 2005-2011 Georgia SEER cancer registries were aggregated at the county level and by race. A descriptive borrowing approach was implemented to describe the heterogeneity of CRC mortality. A conditional auto-regressive (CAR) Bayesian model – a disease mapping method – was used to examine spatial patterns of mortality and whether area-level factors were drivers in the variation seen. Area-level data were obtained from the American Community Survey 5-year estimates, for the period 2006-2010. To determine whether area-level factors were drivers of heterogeneity, the DIC, model fit statistic, was compared between models.
Results: The descriptive borrowing approach suggests that there is moderate spatial heterogeneity of CRC mortality across counties in Georgia by both NHW and NHB groups. Among NHW, excess deaths appeared more in the southeastern region of Georgia. Among NHB, excess deaths appeared more in the western region of Georgia. The CAR Bayesian model suggests that there is moderate spatial heterogeneity of CRC mortality among NHW but little variation among NHB. For both NHW and NHB, area-level poverty and area-level education did not explain the observed variation.
Conclusion: This analysis provides evidence of moderate spatial heterogeneity of CRC mortality in Georgia. Further research should establish other factors that may be contributing to heterogeneity to better target specific interventions that aim to improve the mortality disparity.
Table of Contents
CHAPTER I: BACKGROUND/LITERATURE REVIEW 1
1.1 Mortality of Colorectal Cancer 1
1.1.2 Age and CRC Mortality 1
1.1.3 Anatomic Site Differences and CRC Mortality 2
1.2 Geographic Variation in CRC Mortality 2
1.3 Race and CRC Mortality 3
1.4 Neighborhood and Structural Factors and CRC Mortality 3
1.5 Significance of thesis 4
1.6 Aims of thesis 5
CHAPTER II: SPATIAL HETEROGENEITY OF COLORECTAL CANCER MORTALITY
2.1 Abstract 6
2.2 Introduction 8
2.3 Methods 10
2.4 Results 17
2.5 Discussion 20
2.6 References 23
2.7 Tables & Figures 27
CHAPTER III: SUMMARY, PUBLIC HEALTH IMPLICATIONS, POSSIBLE FUTURE DIRECTIONS 34
4 Appendices 36
4.1 Appendix A 41
4.2 Appendix B 42
4.3 Appendix C 43
4.4 Appendix D 44
4.5 Appendix E 45
4.6 Appendix F 46
About this Master's Thesis
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