Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar 11;6(3):e03484.
doi: 10.1016/j.heliyon.2020.e03484. eCollection 2020 Mar.

Fundamental social causes of inequalities in colorectal cancer mortality: A study of behavioral and medical mechanisms

Sean A P Clouston  1 , Julia Acker  2 , Marcie S Rubin  3 , David H Chae  4 , Bruce G Link  5
Affiliations

Fundamental social causes of inequalities in colorectal cancer mortality: A study of behavioral and medical mechanisms

Sean A P Clouston et al. Heliyon. .

Abstract

Background: Fundamental cause theory posits that social conditions strongly influence the risk of health risks. This study identifies risk mechanisms that social conditions associated with socioeconomic status (SES) and race/ethnicity shape in the production of colorectal cancer (CRC) mortality.

Methods: Two large datasets in the United States examining behavioral and medical preventive factors (N = 4.63-million people) were merged with population-level mortality data observing 761,100 CRC deaths among 3.31-billion person-years of observation to examine trends in CRC mortality from 1999-2012. Analyses examined the changing role of medical preventions and health behaviors in catalyzing SES and racial/ethnic inequalities in CRC mortality.

Results: Lower SES as well as Black, Hispanic, Asian/Pacific Islander, and Native American race/ethnicity were associated with decreased access to age-appropriate screening and/or increased prevalence of behavioral risk factors. Analyses further revealed that SES and racial/ethnic inequalities were partially determined by differences in engagement in two preventive factors: use of colonoscopy, and participation in physical activity.

Discussion: Social inequalities were not completely determined by behavioral risk factors. Nevertheless, a more equitable distribution of preventive medicines has the potential to reduce both the risk of, and social inequalities in, CRC mortality.

Keywords: Behavior; Cancer epidemiology; Demography; Epidemiology; Fundamental cause theory; Gastrointestinal system; Longitudinal; Medical sociology; Oncology; Physical activity; Public health; Social geography; Social inequality.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Prevalence of behaviors linked to colorectal cancer risk and use of screening techniques weighted to the United States resident population aged 25 and older, Behavioral and Risk Factor Surveillance Study 1999–2012.
See this image and copyright information in PMC

References

    1. American Cancer Society . 2013. Survival Rates for Colorectal Cancer.http://www.cancer.org/cancer/colonandrectumcancer/overviewguide/colorect... Colorectal cancer overview.
    1. American Cancer Society . American Cancer Society; 2016. Colorectal Cancer Prevention and Early Detection. Vol. Cancer.org.
    1. Arem H., Pfeiffer R.M., Engels E.A., Alfano C.M., Hollenbeck A., Park Y., Matthews C.E. Pre- and postdiagnosis physical activity, television viewing, and mortality among patients with colorectal cancer in the National Institutes of Health-Aarp Diet and health study. J. Clin. Oncol. 2015;33(2):180–188. - PMC - PubMed
    1. Asha Asha, Gayathri Devaraja. Synergistic impact of lactobacillus fermentum, lactobacillus plantarum and vincristine on 1, 2-dimethylhydrazine-induced colorectal carcinogenesis in mice. Exp. Ther. Med. 2012;3(6):1049–1054. - PMC - PubMed
    1. Atkin W.S., Edwards R., Kralj-Hans I., Wooldrage K., Hart A.R., Northover J.M., Parkin D.M., Wardle J., Duffy S.W., Cuzick J., Flexible U.K., Sigmoidoscopy Trial Investigators Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet. 2010;375(9726):1624–1633. - PubMed