Geographic variation in colorectal cancer survival and the role of small-area socioeconomic deprivation: a multilevel survival analysis of the NIH-AARP Diet and Health Study Cohort

UMMS Affiliation

Department of Family Medicine and Community Health; Meyers Primary Care Institute; Department of Psychiatry

Publication Date


Document Type



Aged; Bayes Theorem; Cause of Death; Cohort Studies; Colorectal Neoplasms; Consumer Organizations; Female; Geography; *Health Status Disparities; Humans; Male; Middle Aged; National Institutes of Health (U.S.); Poverty; Prospective Studies; Questionnaires; Retirement; Risk Factors; Socioeconomic Factors; Survival Analysis; Unemployment; United States


Community Health and Preventive Medicine | Digestive System Diseases | Investigative Techniques | Neoplasms | Pathological Conditions, Signs and Symptoms | Preventive Medicine | Primary Care


Adverse socioeconomic conditions, at both the individual and the neighborhood level, increase the risk of colorectal cancer (CRC) death, but little is known regarding whether CRC survival varies geographically and the extent to which area-level socioeconomic deprivation affects this geographic variation. Using data from the National Institutes of Health (NIH)-AARP Diet and Health Study, the authors examined geographic variation and the role of area-level socioeconomic deprivation in CRC survival. CRC cases (n = 7,024), identified during 1995-2003, were followed for their CRC-specific vital status through 2005 and overall vital status through 2006. Bayesian multilevel survival models showed that there was significant geographic variation in overall (variance = 0.2, 95% confidence interval (CI): 0.1, 0.2) and CRC-specific (variance = 0.3, 95% CI: 0.1, 0.4) risk of death. More socioeconomically deprived neighborhoods had a higher overall risk of death (most deprived quartile vs. least deprived: hazard ratio = 1.2, 95% CI: 1.1, 1.4) and a higher CRC-specific risk of death (most deprived quartile vs. least deprived: hazard ratio = 1.2, 95% CI: 1.1, 1.5). However, neighborhood socioeconomic deprivation did not account for the geographic variation in overall and CRC-specific risks of death. In future studies, investigators should evaluate other neighborhood characteristics to help explain geographic heterogeneity in CRC survival. Such research could facilitate interventions for reducing geographic disparity in CRC survival.


cohort studies, colorectal neoplasms, geography, multilevel analysis, residence characteristics, socioeconomic factors, survival

DOI of Published Version



Am J Epidemiol. 2011 Oct 1;174(7):828-38. Epub 2011 Aug 11. Link to article on publisher's site

Journal/Book/Conference Title

American journal of epidemiology

Related Resources

Link to Article in PubMed

PubMed ID