This study explored the incidence of colorectal cancer (CRC) and assessed the predictors of the late stage diagnosis of CRC in Kentucky. It compared the distribution of CRC incidence in the Appalachian and non-Appalachian regions of Kentucky, and between Kentucky and the United States (U.S.). At total of 21,004 Kentuckian CRC patients diagnosed during the years 1995-2002 were included in the study. The study assessed the influence of living distant and less densely populated areas on the incidence of CRC and prevalence of late stage CRC. Also, it measured the risk of smoking, having a previous family history of CRC, and not having health insurance at the time of diagnosis on the incidence of late stage CRC.
Three studies were conducted. An integrative literature review was first performed to provide background on CRC, define the measures used in the study, and assess the risk factors that are known to influence the stage of CRC at diagnosis. The second study is descriptive epidemiology. It presented the CRC incidence rates in Kentucky by age groups, gender, and geographic regions. The third study assessed the predictors of late stage CRC at diagnosis.
The second study showed that the incidence rates of CRC in both Kentucky and the U.S. are higher for males than females. Kentucky has higher rates of all stages of CRC for all age groups and both genders than the U.S. For both gender groups younger than 60 years, the Appalachian regions have a higher incidence of late stage CRC than the non-Appalachian regions of Kentucky. However, these rates are higher in the non-Appalachian regions for patients at age 60 years and older. Many studies reported a higher incidence of CRC in regions known to have higher prevalence of CRC risk factors including smoking, uninsured, and a previous family history of CRC. The third study provides evidence that smokers have a higher incidence of late stage CRC than non-smokers. It shows that having a family history is associated with lower incidences of late stage CRC. Also, it shows that uninsured patients at the time of diagnosis are at higher risk to be diagnosed with late stage CRC. Results from the logistic model revealed that living in rural Appalachia of Kentucky is associated with a higher incidence of late stage CRC. Also, it provides evidence that people who are younger than 60 years are more likely to have late stage CRC at diagnosis than those who are 60 years and older.
These studies provide evidence that residence in the Appalachian regions of Kentucky are less likely to use screening and preventive measures for CRC, and may have higher prevalence of CRC risk factors. Implications of this study include the promotion of policies that increase the awareness of CRC screening and preventive measures in Kentucky and specifically in the Appalachian region of Kentuky.
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