Faculty, Staff and Student Publications

Language

English

Publication Date

8-8-2026

Journal

Cancer Causes & Control

DOI

10.1007/s10552-026-02223-3

PMID

42570131

PMCID

PMC13452776

PubMedCentral® Posted Date

8-8-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Purpose: Colorectal cancer (CRC) remains a leading cause of cancer morbidity and mortality in the United States and shows substantial geographic variation. Socioeconomically disadvantaged communities experience elevated CRC incidence, yet few studies have analyzed multi-decade poverty measures for long-term structural disadvantage.

Methods: We analyzed CRC incidence from 2017 to 2021 across Texas using Texas Cancer Registry data. Age-sex-race/ethnicity standardized cases were incorporated as offsets in Bayesian spatial models to generate tract-level posterior mean relative risks. We evaluated four tract-level poverty measures (high poverty in 2021; persistent poverty since 1990; enduring poverty since 1980 and 1970), Rural-Urban Commuting Area (RUCA) classifications, and CRC screening rates among adults aged 50-75 years.

Results: Long-term poverty and rurality were independently associated with elevated CRC risk. Compared with urban tracts, micropolitan and rural tracts had 7-8% higher risks. Poverty measures defined over longer durations showed stronger associations with CRC incidence: high poverty in 2017-2021 (RR = 1.04, 95% CrI: 1.01-1.07), persistent poverty since 1990 (RR = 1.04, 1.00-1.08), enduring poverty since 1980 (RR = 1.06, 1.01-1.11), and enduring poverty since 1970 (RR = 1.09, 1.04-1.15). Higher tract-level CRC screening prevalence was inversely associated with CRC incidence (RR per 1% increase = 0.99).

Conclusion: Long-term poverty and rural residence were associated with elevated CRC risk in Texas, even after adjusting for screening prevalence. Multi-decade poverty measures and updated RUCA classifications identified geographic disparities not captured by single-year poverty indicators and supported geographically targeted screening, prevention, and resource allocation efforts. These results can inform geographically targeted, efficiency-focused screening and prevention strategies, particularly in communities experiencing decades of structural disadvantage.

Keywords

Humans, Colorectal Neoplasms, Texas, Female, Middle Aged, Poverty, Rural Population, Male, Socioeconomic Disparities in Health, Incidence, Aged, Spatial Analysis, Early Detection of Cancer, Registries, Colorectal, Cancer, Geospatial, Persistent, Poverty, Rural

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