Fundamental social causes of inequalities in colorectal cancer mortality: A study of behavioral and medical mechanisms

• Published in: Heliyon Vol. 6; no. 3; p. e03484
• Main Authors: Clouston, Sean A.P., Acker, Julia, Rubin, Marcie S., Chae, David H., Link, Bruce G.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2020; Elsevier
• Subjects: Behavior; Cancer epidemiology; Demography; Epidemiology; Fundamental cause theory; Gastrointestinal system; Longitudinal; Medical sociology; Oncology; Physical activity; Public health; Social geography; Social inequality; Demography; Longitudinal; Physical activity; Medical sociology; Oncology; Epidemiology; Fundamental cause theory; Social inequality; Gastrointestinal system; Cancer epidemiology; Behavior; Social geography; Public health
• ISSN: 2405-8440; 2405-8440
• DOI: 10.1016/j.heliyon.2020.e03484

Fundamental cause theory posits that social conditions strongly influence the risk of health risks. This study identifies risk mechanisms that social conditions associated with socioeconomic status (SES) and race/ethnicity shape in the production of colorectal cancer (CRC) mortality. Two large datasets in the United States examining behavioral and medical preventive factors (N = 4.63-million people) were merged with population-level mortality data observing 761,100 CRC deaths among 3.31-billion person-years of observation to examine trends in CRC mortality from 1999-2012. Analyses examined the changing role of medical preventions and health behaviors in catalyzing SES and racial/ethnic inequalities in CRC mortality. Lower SES as well as Black, Hispanic, Asian/Pacific Islander, and Native American race/ethnicity were associated with decreased access to age-appropriate screening and/or increased prevalence of behavioral risk factors. Analyses further revealed that SES and racial/ethnic inequalities were partially determined by differences in engagement in two preventive factors: use of colonoscopy, and participation in physical activity. Social inequalities were not completely determined by behavioral risk factors. Nevertheless, a more equitable distribution of preventive medicines has the potential to reduce both the risk of, and social inequalities in, CRC mortality. Demography; Epidemiology; Gastrointestinal system; Oncology; Physical activity; Public health; Social geography; Social inequality; Cancer epidemiology; Fundamental cause theory; Behavior; Medical sociology; Longitudinal