Distance to endoscopy services amplifies racial inequities in colorectal cancer mortality in Washington state

• Published in: The American journal of surgery Vol. 235; p. 115732
• Main Authors: Edwards, Ashley, Monroe, Rachel, Amram, Ofer, Kumar, Anjali
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2024; Elsevier Limited
• Subjects: Age; Aged; Buffers; Cancer; Cancer screening; Colonoscopy; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - ethnology; Colorectal Neoplasms - mortality; Death; Disparities in healthcare; Education; Endoscopy; Female; Health care access; Health Services Accessibility - statistics & numerical data; Healthcare Disparities - ethnology; Healthcare Disparities - statistics & numerical data; Hispanic Americans; Human subjects; Humans; Male; Middle Aged; Minority & ethnic groups; Mortality; Race; Racial Groups; Rural health; Variables; Washington - epidemiology; White; Washington; United States > US; Washington (state); Puget Sound; Rural health; Disparities in healthcare; Colonoscopy; Colorectal cancer; Race
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2024.04.003

This study evaluates relationships among race, access to endoscopy services, and colorectal cancer (CRC) mortality in Washington state (WA). We overlayed the locations of ambulatory endoscopy services with place of residence at time of death, using Department of Health data (2011–2018). We compared CRC mortality data within and outside a 10 ​km buffer from services. We used linear regression to assess the impact of distance and race on age at death while adjusting for gender and education level. Age at death: median 72.9y vs. 68.2y for white vs. non-white (p ​< ​0.001). The adjusted model showed that non-whites residing outside the buffer died 6.9y younger on average (p ​< ​0.001). Non-whites residing inside the buffer died 5.2y younger on average (p ​< ​0.001), and whites residing outside the buffer died 1.6y younger (p ​< ​0.001). We used heatmaps to geolocate death density. Results suggest that geographic access to endoscopy services disproportionately impacts non-whites in Washington. These data help identify communities which may benefit from improved access to alternative colorectal cancer screening methods. •This data evaluates health care disparities in Washington state.•Non-whites have earlier mortality from colorectal cancer compared to whites.•Distance from endoscopy worsens early mortality from colorectal cancer in non-whites.•Yakima County has a high concentration of non-white deaths from colorectal cancer.•Yakima County represents a more socioeconomically challenged area overall.