Years of Life and Productivity Loss from Potentially Avoidable Colorectal Cancer Deaths in U.S. Counties with Lower Educational Attainment (2008-2012)

Abstract

Background: Educational attainment (EA) is inversely associated with colorectal cancer risk. Colorectal cancer screening can save lives if precancerous polyps or early cancers are found and successfully treated. This study aims to estimate the potential productivity loss (PPL) and associated avoidable colorectal cancer-related deaths among screen-eligible adults residing in lower EA counties in the United States.Methods: Mortality and population data were used to examine colorectal cancer deaths (2008-2012) among adults aged 50 to 74 years in lower EA counties, and to estimate the expected number of deaths using the mortality experience from high EA counties. Excess deaths (observed-expected) were used to estimate potential years life lost, and the human capital method was used to estimate PPL in 2012 U.S. dollars.Results: County-level colorectal cancer death rates were inversely associated with county-level EA. Of the 100,857 colorectal cancer deaths in lower EA counties, we estimated that more than 21,000 (1 in 5) was potentially avoidable and resulted in nearly $2 billion annual productivity loss.Conclusions: County-level EA disparities contribute to a large number of potentially avoidable colorectal cancer-related deaths. Increased prevention and improved screening potentially could decrease deaths and help reduce the associated economic burden in lower EA communities. Increased screening could further reduce deaths in all EA groups.Impact: These results estimate the large economic impact of potentially avoidable colorectal cancer-related deaths in economically disadvantaged communities, as measured by lower EA. Cancer Epidemiol Biomarkers Prev; 26(5); 736-42. ©2016 AACR.

Figure 1

Age-standardized colorectal cancer death rates (ASDR) among ages 50–74 years by county-level educational attainment^* and sex, all races combined (2008–2012). NOTE: County-level educational attainment was categorized from high to low educational attainment according to the percentage of residents ages ≥25 years graduated college as follows: Q1, ≥36.19%; Q2, 29.66%–36.18%; Q3, 25.91%–29.65; Q4: 18.88%–25.90%; and Q5: <18.88%.

Figure 2

Potential productivity loss (PPL) due to potentially avoidable excess colorectal cancer deaths among decedents ages 50–74 years in counties with medium-and low-educational attainment by sex and race/ethnicity (2008–2012). NOTE: County-level educational attainment was categorized from high to low educational attainment according to the percentage of residents ages ≥25 years graduated college as follows: Q1, ≥36.19%; Q2: 29.66%–36.18%; Q3, 25.91%–29.65; Q4, 18.88%–25.90%; and Q5, <18.88%.