Skip to main content
2025 ASCRS Annual Scientific Meeting Main banner
Final Program


Visit ASCRS U
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
CME
CME
Invitation/Ticketed Event
Invitation/Ticketed Event
Invited Lectureship
Invited Lectureship
Award Recipient
Award Recipient
Self-Assessment
Self-Assessment
Social
Social
Industry
Industry
Back

Session: ePoster: Colon and Colorectal Cancer 9 (Mon8)

EP636 - Rural-urban colorectal cancer mortality disparities mediated by neighborhood factors

Monday, May 12, 2025
8:27 AM – 8:32 AM PT
Location: Monitor 5, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Sara Myers, MD

    Resident
    Boston University/Boston Medical Center
    Boston, MA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • ED

    Elizabeth S. Davis, MSPH

    Data Analyst
    Boston Medical Center, Boston University
    Boston, Massachusetts, United States

    Disclosure information not submitted.

  • Jennifer Davids, MD, FACS, FASCRS (she/her/hers)

    Chief of Colon and Rectal Surgery
    Boston Medical Center/Boston University School of Medicinie
    Boston University
    Boston, Massachusetts, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

    • Senior Author(s)

  • KK

    Kelly Kenzik, MS, PhD

    Associate Professor and the Associate Chair for Research in the Department of Surgery
    Boston Medical Center, Boston University
    Boston, Massachusetts, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Sara Myers, MD: This individual has no financial relationships with ineligible companies.
Jennifer Davids, MD, FACS, FASCRS: This individual has no relevant relationships with ineligible companies.
Kelly Kenzik, MS, PhD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Rural-urban disparities in colorectal cancer (CRC) mortality have been attributed to various individual and population level factors. Population-level measures such as Social Vulnerability Index (SVI), which incorporates socioeconomic status (SES), household characteristics, racial & ethnic composition, and housing & transportation, can be used to investigate the etiology of rural-urban disparities. However, the contribution by each SVI factor to CRC mortality disparities among rural and urban counties is unknown. We evaluated the extent of mediation by each SVI factor on the rural-urban CRC mortality disparity.

Methods/Interventions: Using pooled CRC mortality data for all counties in the US from 1999-2020 from the Centers for Disease Control and Prevention (CDC),we examined rural-urban differences in county demographic data (age, race, language, education, income, unemployment, CRC mortality rate) and in each of 16 SVI factors. Risk of CRC mortality was assessed using univariate and multivariable Poisson regression models. The proportion of the rural-urban mortality difference mediated by specific SVI factors was calculated using effect decomposition.

Results/Outcomes: Among 2927 counties (rural 60.7%; urban 39.3%), rural counties had 11.8% higher CRC mortality than urban counties (27.6 vs 24.7 per 100,000); 18.6% of that disparity was mediated by low SES, 8.8% by household characteristics, 2.7% by racial/ethnic minority status, and 0.02% by housing type/transportation. Composite SVI explained 8% of the mortality difference. In univariate analysis, poverty (IRR 3.2, 95% CI 2.8-3.5), unemployment (IRR 5.4, 95% CI 4.4-6.8), lacking a high school diploma (IRR 2.7, 95% CI 2.4-2.9), household crowding (IRR 3.3, 95% CI 2.5-4.4), lacking a vehicle (IRR 3.4, 95% CI 3.0-3.8), and single-parent households (IRR 7.6, 95% CI 6.2-9.3) had the greatest impact on CRC mortality among all counties. Compared to urban counties, rural counties with a higher proportion of people without a vehicle had a higher risk of CRC mortality(IRR 4.3, 95% CI 3.7-5.0 vs IRR 1.9, 95% CI 1.5-2.4).

Conclusion/Discussion: Rural counties have higher CRC mortality than urban counties, and this disparity is largely driven by low SES- higher poverty and unemployment, lower income and education. In contrast, race only mediated 2.7% of the rural-urban CRC mortality difference. These findings indicate that the relationship between CRC mortality and SVI is more nuanced than the composite SVI suggests, and that rural and urban counties have different needs. Evaluating the contribution of each component of SVI to CRC mortality may allow for more targeted interventions than by evaluating SVI alone.