Causes of Socioeconomic Disparities in Colorectal Cancer and Intervention Framework and Strategies

Abstract

Colorectal cancer (CRC) disproportionately affects people from low socioeconomic backgrounds and some racial minorities. Disparities in CRC incidence and outcomes might result from differences in exposure to risk factors such as unhealthy diet and sedentary lifestyle; limited access to risk-reducing behaviors such as chemoprevention, screening, and follow up of abnormal test results; or lack of access to high-quality treatment resources. These factors operate at the individual, provider, health system, community, and policy levels to perpetuate CRC disparities. However, CRC disparities can be eliminated. Addressing the complex factors that contribute to development and progression of CRC with multicomponent, adaptive interventions, at multiple levels of the care continuum, can reduce gaps in mortality. These might be addressed with a combination of healthcare and community-based interventions and policy changes that promote healthy behaviors and ensure access to high-quality and effective measures for CRC prevention, diagnosis, and treatment. Improving resources and coordinating efforts in communities where people of low-socioeconomic status live and work would increase access to evidence-based interventions. Research is also needed to understand the role and potential mechanisms by which factors in diet, intestinal microbiome, and/or inflammation contribute to differences in colorectal carcinogenesis. Studies of large cohorts with diverse populations are needed to identify epidemiologic and molecular factors that contribute to CRC development in different populations.

Colorectal cancer statistics, 2020

“…Reasons for racial disparities in CRC are complex but largely reflect differences in risk factor prevalence and health care access driven by disproportionately low socioeconomic status among black individuals . In 2018, the median family income was $41,361 among blacks compared with $70,642 among NHWs, with 21% and 8%, respectively, living in poverty .…”

Small Cell Carcinoma as an Independent Prognostic Factor for Cervical Cancer Patients: A Population-Based Analysis

“…Both pathological types are more likely to occur in single women and in white patients. This could be explained by the fact that socioeconomic psychological factors and genetic diversity might play an important role in tumorigenesis and tumor progression (20)(21)(22). Several previous studies did demonstrate that marital status and ethnicities were important etiological and prognostic factors in several solid tumors, including cervical cancer (23)(24)(25)(26).…”

Disparities in Cancer Prevention in the COVID-19 Era

“…women in the lowest income bracket are significantly less likely to be up to date with breast cancer screening than women in the highest income bracket and adults; the same income differential is observed for colorectal cancer screening, with those in the lowest income bracket significantly less likely to be up to date with colorectal cancer screening than adults who are in higher income brackets (Figure 1) [10]. Additionally, there is often higher prevalence of cancer risk factors such as tobacco and alcohol use and ingestion of high fat, high caloric diets that predispose these populations to a higher risk of cancer formation [15]. In addition, certain medically-underserved populations have longstanding fear of "going to the doctor" for cultural and/or historical exploitation reasons [16].…”