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Understanding the burden of colorectal cancer in a three-county rural region of Michigan: an ecological analysis of incidence, mortality, and risk factors

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Abstract

Purpose

Our aim was to identify whether known colorectal cancer (CRC) risk factors contribute to the high CRC burden in Michigan’s Thumb region, a 3-county agricultural rural area in eastern Michigan.

Methods

We examined county-level invasive CRC incidence and mortality rates (2000–2017) from the Michigan Cancer Surveillance Program and county-level data on CRC risk factors from publicly available datasets. Prevalence of CRC risk factors in the Thumb region were compared to Michigan’s other rural and urban regions using ANOVA (Analysis of Variance) tests. Multivariable linear regression models with stepwise selection were used to assess whether living in the Thumb region was associated with increased CRC incidence, mortality, and late-stage diagnoses after accounting for other risk factors.

Results

Living in the Thumb region (β = 10.4, p = 0.0003), obesity (β = 36.9, p = 0.04), and an unhealthy food environment (β = − 2.7, p = 0.003) were associated with higher CRC incidence. Smoking (β = 67.3, p < 0.0001), being uninsured (β = − 29.9%, p = 0.03), living in the Thumb region (β = 2.47, p = 0.03), lower colonoscopy screening (β = − 0.14, p = 0.01), and older age (β = 0.11, p = 0.006) were associated with higher CRC mortality. The percent of late-staged CRC diagnoses was significantly lower in the Thumb region than other rural and urban areas of the state (52.9%, 58.3%, and 54.6%, respectively, p = 0.03).

Conclusion

Findings suggest that living in Michigan’s Thumb region is associated with higher CRC incidence and mortality compared to Michigan’s other rural and urban regions, even after controlling for known risk factors. More studies on individual-level demographic, environmental, tumor, and treatment characteristics (e.g., treatment differences, water quality, pesticide use) are needed to further characterize these findings.

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Data availability

All datasets were taken from publicly available sources.

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Corewell Health General Surgery Residency, 100 Michigan Street, Suite A601, Grand Rapids, MI, 49503, USA

    Allison Hoppe

  2. Department of Surgery, College of Human Medicine, Michigan State University, East Lansing, MI, USA

    Allison Hoppe

  3. Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA

    Kelly Hirko

  4. Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA

    Andrea Wendling

Authors
  1. Allison Hoppe
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  2. Kelly Hirko
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  3. Andrea Wendling
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Contributions

AH—Conceptualization, methodology, investigation, visualization, and writing (original draft); KH—Conceptualization, methodology, validation, formal analysis, data curation, writing (reviewing and editing), and supervision; AW—Conceptualization, methodology, validation, writing (reviewing and editing), and supervision.

Corresponding author

Correspondence to Allison Hoppe.

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Conflict of interest

No authors have any financial or personal competing interests to disclose.

Ethical approval

The Institutional Review Board at Michigan State University reviewed this study and determined that it was not human research.

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Hoppe, A., Hirko, K. & Wendling, A. Understanding the burden of colorectal cancer in a three-county rural region of Michigan: an ecological analysis of incidence, mortality, and risk factors. Cancer Causes Control 35, 153–159 (2024). https://doi.org/10.1007/s10552-023-01776-x

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  • DOI: https://doi.org/10.1007/s10552-023-01776-x

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