The risk of dying following a colon cancer diagnosis is disproportionately higher among people who have a high school education or less, a study concludes. Both men and women who attended school for 12 years or fewer had significantly higher death rates from the disease. That finding was consistent in most U.S. states and across racial backgrounds, the report found.
“It's a combination of risk factors and access to care,” said Dr. Ahmedin Jemal, vice-president of surveillance research for the American Cancer Society and the lead author of the report published Monday in the Journal of Clinical Oncology. “Individuals with lower educational attainment have a higher prevalence of known risk factors for colorectal cancer, such as smoking and obesity. And they are also more likely to be uninsured and have limited access to preventive education and early treatment services,” he explained.
Researchers from the American Cancer Society used educational attainment as a marker of socio-economic status and looked at the impact on colon cancer deaths among U.S. adults ages 25 to 64 from 2008 to 2010, before the rollout of the Patient Protection and Affordable Care Act. Data was obtained from the CDC's National Center for Health Statistics and U.S. Census Bureau population survey data.
They compared outcomes by state, race and ethnicity and education level, and also estimated the proportion of annual colon cancer deaths that could potentially have been avoided if racial, socio-economic and geographic inequalities had been eliminated. When compared to individuals with a bachelor's degree or higher, those with a high school diploma or less had significantly higher colon cancer death rates.
There were 11.3 deaths per 100,000 patients among whites who completed 12 years of schooling or less, but that number dropped by more than half, to 5.3, among those with a college education or higher. Among black patients, there were 16.7 deaths per 100,000 patients among patients with a high school diploma or less; that number fell to 9.2 among black college graduates. Among Hispanics, the numbers were 6.7 and 4.3 respectively. The trend remained consistent in most states, the study found.
Of 46,538 colon cancer deaths that occurred nationwide during the three years studied, approximately half could have been avoided.
Future studies could examine the effect of the Affordable Care Act, which aimed to increase access to preventive-care services, including colon cancer screening, the authors say. “It all comes back to prevention,” said Jemal, who encourages healthcare providers to recommend colorectal cancer screenings to all eligible patients to help boost rates to 80% among the eligible population by 2018.
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