Trends in the Incidence of Colorectal Cancer in Relation to County-Level Poverty among Blacks and Whites

Objective: The overall incidence of colorectal cancer has been decreasing rapidly in the United States since 1998. The extent to which the recent accelerated decline varies by socioeconomic status has not been examined. We analyzed trends in colorectal cancer incidence rates from 1992-2004 by area socioeconomic status, race, gender and stage at diagnosis. Methods: Incidence data from 13 Surveillance, Epidemiology and End Results reporting areas were used to examine temporal trends in age-standardized colorectal cancer incidence rates from 1992-2004 by race, gender, stage at diagnosis and 3 levels of county poverty (counties with < 10%, 10% to < 20% and >= 20% of residents living below the poverty level). Results: Among whites, colorectal cancer incidence rates decreased in both men and women residing in low- and moderate-poverty areas. The decrease involved both early- and late-stage disease in men and-late-stage disease in women. In contrast, among those residing in high-poverty are-as incidence rates increased for early-stage disease in men; rates were stable for late-stage, disease in men and for both categories of stage in women. Among blacks, incidence rates decreased only in men residing in low-poverty areas. Conclusions: The recent decrease in colorectal cancer incidence has not yet benefited persons residing in high-poverty,areas. Additional effort is needed to extend prevention and early detection measures to all segments of the population.