Abstract PR-10: Poverty, insurance status, and colorectal cancer in Colorado: 1995-2006.

Poverty in Colorado is an important factor that lowers the advantages of being diagnosed with colorectal cancer (CRC) at the earlier stage of disease and decreases survival due to CRC. Health insurance status can also lead to disparities in early detection of CRC.

Data from the Colorado Central Cancer Registry in the Colorado Department of Public Health and Environment and information from the 2000 U.S. census were used to determine the proportions of Colorado residents with CRC residing in areas designated as “less than 10% poverty” or wealthier areas, “10-19% poverty” or middle poverty areas, and “20+% poverty” or poorest areas. Since income was not reported to the cancer registry, the poverty level of the census block group area, obtained through the 2000 U.S. Census, where each cancer case resided was used to assign the poverty level for that case. The analyses presented included CRC cases over a 12-year period, from 1995-2006, in order to compare early stage diagnosis by area poverty level and age (less than 65 vs. 65 and older). Early stage at CRC diagnosis and insurance status by area poverty level for 1998-2006 and five-year cause-specific survival among Colorado CRC cases from 1999-2002 were also analyzed.

Among the 21,212 colorectal cancer cases reported to the cancer registry from 1995-2006, 64.5% resided in wealthier areas, 24.8% were from middle poverty areas, and 10.7 % were from the poorest areas of the state. The proportion of early stage diagnosis was lower among the CRC cases from the poorest areas (42.0%) compared to those from the wealthier areas (44.2%). Among those less than aged 65, there was a substantial decrease in early stage at CRC diagnosis as poverty level increased (42.0% from wealthier areas vs. 37% from poorest areas). This is in contrast to those aged 65 and older (45.5% from wealthier areas vs. 44.4% from the poorest areas). In addition, of those younger than age 65 whose insurance status was available from the cancer registry for 1998-2006 (n=5,288), having no insurance or only Medicaid coverage was a disadvantage for early stage diagnosis compared to those with private insurance in all three poverty groups. More importantly, five-year cause-specific survival decreased as poverty level increased (64.1% from wealthier areas, 58.1% from middle poverty areas, 50.8% from the poorest areas of the state). This association between survival differences and socioeconomic status was apparent in those younger than 65 (67.8%, 66.9%, 48.7%) and in those 65 and older (61.5%, 53.9%, 51.9%).

Poverty and lack of health insurance are disadvantages that lead to disparities in early detection of and survival from colorectal cancer.

Citation Information: Cancer Prev Res 2008;1(7 Suppl):PR-10.