People with lower socioeconomic status remain at higher risk of dying from colon cancer

The Milbank QuarterlyOct 6 2012

Despite medical advances in colon cancer screening and treatment, people with a lower socioeconomic status remain at a higher risk of dying from colon cancer. A new study in The Milbank Quarterly finds that states and communities that focus on increasing the adoption of innovative health care practices along with providing greater access to public health information can reduce these deaths.

This year, over 50,000 people in the U.S. are projected to die from colon cancer and one in 20 people will be diagnosed with the disease. Since colon cancer usually progresses over 7 to 10 years before becoming deadly, early detection and treatment can save numerous lives.

"But because people do not seek or are blocked from seeking preventive treatments, this can have deadly consequences for many," said the study's lead author, Andrew C. Wang, M.P.H., at Columbia University's Mailman School of Public Health, New York. "However, our results are hopeful in this sense. They suggest that we could attack this problem by more efficiently diffusing this information to those who are least likely to access it on their own."

Researchers identified U.S. patients who died from colorectal cancer between 1968 and 2008 and examined socioeconomic (SES) disparities and differences in state levels of health information diffusion. States with policies designed to promote health care innovation and the effective diffusion of health information to the public and clinicians have been previously linked to improvement in health status.

The researchers found that deaths from colon cancer in the highest SES counties decreased over the 40 year period while deaths increased in lower SES counties. In addition, states with high rates of health information diffusion had substantial declines in deaths, while states with low diffusion had comparatively lower declines. Notably, higher rates of health information diffusion lessened the impact of low SES on colon cancer deaths.

Encouraging the faster spread of information "at all levels of society, including patients and providers, may have a large impact on reducing both colorectal cancer mortality and the social inequalities observed in colorectal cancer mortality," the researchers wrote.

Mark E. Benson, M.D., assistant professor of gastroenterology and endoscopy at the University of Wisconsin, School of Medicine and Public Health said, "The study was interesting in that while it is well known that socioeconomic factors often play a part in having access to colon cancer screening, a consumer's motivation to seek information regardless of whether they have access to health insurance also plays a part in cancer prevention."

Benson pointed out that with so much information available to consumers via the Internet, medical sources and intra-personal relationships today it is surprising that there is a disparity of education about colon cancer.

"Yet, I see that disparity all the time in my practice," he said. "Some patients are well informed prior to the screening procedure and others are not. Educating patients about the importance of colon cancer screening is a complicated process but vitally important because it can save lives."

Wang added, "Not everyone has the resources to pay for preventive services, but to increase population health we need to improve outcomes among individuals who are less likely to hear about, discuss and use information to its maximum capacity."