Rural/nonrural differences in colorectal cancer incidence in the United States, 1998-2001

BACKGROUND. Few studies of colorectal cancer incidence by rural, suburban, and metropolitan residence have been published. METHODS. The authors examined colorectal cancer incidence among men and women in U.S. counties classified as rural, suburban, and metropolitan for the period 1998-2001. They examined rural/suburban/metropolitan differences in incidence by age, race, Hispanic ethnicity, stage at diagnosis, histology, and percentage of the total county population below the poverty level, using data from the CDC's National Program of Cancer Registries, the NCI's Surveillance, Epidemiology, and End Results Program, and the 2000 U.S. Census. RESULTS. A total of 495,770 newly diagnosed or incident cases of colorectal cancer were included in this analysis (249,919 among men and 245,851 among women). Over the period 1998-2001, the colorectal cancer incidence rates among men tended to be lower among those who resided in rural areas, for each of the subgroups examined, with the exception of Asians and Pacific Islanders and those living in more affluent counties. Among women aged 75 years and older, the colorectal cancer incidence rates tended to be lower among rural than metropolitan or suburban residents, though the differences were slight. In multivariate analysis, the incidence of colorectal cancer was higher in metropolitan, suburban, and rural areas for blacks than that for whites (incidence rate ratios [RR] = 1.12, 1.07, and 1.06, respectively, all P < 0.015). CONCLUSIONS. This study suggests that black men who reside in metropolitan areas have a higher risk of colorectal cancer than black men who reside in rural areas. This finding suggests the need for diverse approaches for reducing colorectal cancer when targeting rural compared with metropolitan areas.