142nd APHA Annual Meeting and Exposition

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Colon cancer among American Indians/Alaska Natives and Non-Hispanic Whites: Impact of race and travel time to treatment and screening on survival

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 9:10 AM - 9:30 AM

Sharon Austin, PhD , Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
Antoinette Stroup, PhD , Division of Cancer Epidemiology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
James VanDerslice, PhD , Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
Christina Porucznik, PhD, MSPH , Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
Ken Smith, PhD , Huntsman Cancer Institute and Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT
Stephen Alder, PhD , Family and Preventive Medicine, University of Utah, School of Medicine, Salt Lake City, UT
Introduction: Little is known about the risk factors for colon cancer mortality among North American native populations, American Indians/Alaskan Natives (AI/AN). Even less is known about how geographic access or travel time to treatment and screening impacts rural populations in terms of colon cancer mortality.

Methods: AI/AN (n=302) and non-Hispanic White (NHW; n=94,146) colon cancer cases were selected from the SEER-Medicare linked database (1991-2007). Geographic Information System methodology was used to calculate mean travel times from population-weighted zip centroids up to 10 nearest facility locations. Multivariable Cox proportional hazards regression, stratified by race, was utilized to determine risk for colon cancer mortality, controlling for demographic, diagnostic, and socioeconomic factors.

Results: AI/AN traveling 60+ minutes from a chemotherapy center had an increased risk for colon cancer mortality compared to AI/AN living < 30 minutes away (HR= 2.57, 95% CI 1.39-4.76). Although distance to chemotherapy was not significant among NHW, traveling 60+ minutes to a colonoscopy/sigmoidoscopy screening facility resulted in a 56% increased risk for colon cancer mortality for NHW (HR=1.56, CI 1.16-2.09) compared to NHW living < 30 minutes away from screening facility.

Conclusion: Results suggest that distance may play different roles in colon cancer mortality in different populations. Transportation or closer chemotherapy facilities may decrease colon cancer mortality by improving access for AI/AN.

Learning Areas:

Epidemiology
Public health or related research

Learning Objectives:
List colon cancer risk factors for American Indians/Alaska Natives and Non-hispanic Whites.

Keyword(s): Cancer, Epidemiology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a PhD and MPH in public health and a MS in Medical Anthropology. My research focus has been in the area of cancer epidemiology and I also was part of a patient navigator cancer screening project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4032.0: Cancer Epidemiology and Disparity