QS123 - Appalachian Ailments: Exploring Trends In Colorectal Cancer Rates Across Appalachia

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Purpose/Background: Patients in rural areas face unique challenges in obtaining high quality cancer screenings and treatment. Based on US Census Data, 13.8% of the US population live in “non-metropolitan” counties, which consist of rural towns and small cities with less than 50,000 people. The Appalachian region consists of 423 counties across 13 states: Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and West Virginia. These 13 states vary widely in the amount of their populations that live in non-metropolitan areas: Maryland (4.4%) and New York (7.0%) have low rates of rural populations, while in states such as West Virginia (39.2%), Kentucky (38.2%), and Mississippi (50.8%), a large proportion of the population live in rural areas. This study examines the trends in colorectal cancer (CRC) rates across Appalachia, and highlights the difficulties faced by patients in the more rural Appalachian states.

Methods/Interventions: Data was collected from the CDC US Cancer Statistics and the US Census Bureau American Community Survey. We used these platforms to evaluate incidence rates of CRC across states, further stratified by age and stage of disease.

Results/Outcomes: When looking at all patients with colorectal cancer (all ages and stages), the US national age adjusted incidence rate is 36.4 per 100,000. The CRC incidence rates were greater than 40 cases per 100,000 in the 4 most rural states in Appalachia-AL (40.1 cases per 100,000), WV (44.3), KY (45.9), and MS (46.4). In the less rural states such as VA, NY, and MD, the incidence rates of CRC were lower than the national average. Of the states making up the Appalachian region, 5 states had CRC incidence rates lower than the national average; all these states have rural population rates at or below the national average.

These same trends are found when examining the incidence of CRC in the population aged less than 50 years. The national incidence is 8.8 cases per 100,000. Once again, the incidence of CRC in patients below 50 is highest in the 4 most rural states in Appalachia, ranging from 10-11 cases per 100,000 in AL, WV, KY, and MS.

This trend continues when we examine the incidence of late-stage CRC at the time of diagnosis. The national average was 21.8 cases per 100,000. WV (26.7 cases per 100,000), KY (26.2), and MS (29.0) all had higher than average rates of late-stage disease, while the rest of the Appalachian states had rates comparable to the national average.

The mortality rate of CRC in Appalachia is also higher in the more rural states. The national average CRC mortality rate is 12.9 per 100,000. Only 3 states in Appalachia (MD, NC, and NY) had rates lower than the national average. The three most rural states in the region had mortality rates of greater than 16 per 100,000 people.

Conclusion/Discussion: Patients living in rural areas face unique barriers to obtaining proper cancer screenings and treatment. These include lack of transportation, low socio-economic status, low health literacy, and decreased access to specialty physicians. This study reveals the higher incidence and mortality rates of CRC in the most rural states in Appalachia. These findings lay the groundwork for further research into the barriers to obtaining healthcare in rural areas and exemplify the need for interventions to improve the screening and treatment of CRC in rural areas in Appalachia and across the United States.