Abstract B004: Persistent poverty and geographic disparities in colorectal cancer risk: A Bayesian spatial analysis in Texas

Abstract Background: Colorectal cancer (CRC) disparities exist across geographic areas and remain a persistent public health challenge, particularly in communities facing poverty. Long-term poverty reflects entrenched socioeconomic disadvantages, and rurality has been shown to limit access to care. These factors have not been investigated on CRC, and our study aims to address this gap by examining the association among variables. Methods: We analyzed 54,618 newly diagnosed CRC cases from 2017 to 2021 using Texas Cancer Registry data, aggregated to 6,896 census tracts. Four spatial models were specified. Model A included recent high poverty in 2019 and 2020 rural-urban classification (RUCA). Models B–D sequentially replaced recent poverty with persistent poverty since 1990, 1980, and 1970, respectively. Models were fitted using Poisson Besag–York–Mollié 2 (BYM2) framework to capture both spatially structured and unstructured variation. Bayesian inference was conducted using Integrated Nested Laplace Approximation (INLA), and CRC risk hotspots were identified using exceedance analysis. Results: Across all models, CRC risk was significantly higher in micropolitan and rural areas, compared to urban tracts. Specifically, micropolitan tracts had a moderately elevated risk (RR = 1.080–1.087), while rural tracts had an even greater risk (RR = 1.268–1.278). Model A showed no significant association between recent high poverty in 2019 and CRC risk (RR = 0.991, 95% CI: 0.960–1.022). Model B similarly showed no significant association with persistent poverty since 1990 (RR = 1.007, 95% CI: 0.967–1.049). In contrast, Model C indicated higher CRC risk in tracts with persistent poverty since 1980 (RR = 1.095, 95% CI: 1.039–1.154), and Model D had a slightly higher association for persistent poverty since 1970 (RR = 1.144, 95% CI: 1.078–1.213) than Model C. Conclusions: Colorectal cancer risk is significantly shaped by deep-rooted socioeconomic conditions, including long-term poverty and rurality-urbanicity. High risk or CRC in high poverty and deeply entrenched poverty areas suggested that recent economic hardship and cumulated structural disadvantage may contribute to increased disease burden. These findings highlight the urgent need for targeted cancer prevention strategies that address rural health disparities and long-standing economic deprivation. This work was supported by funding from the National Cancer Institute of the National Institutes of Health (Award Number 1U54CA280804). The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health. We thank MD Anderson research staff who assisted with implementation of the Acres Homes Cancer Prevention Collaboration and especially thank the Be Well Acres Homes Steering Committee, and community advisors for their contributions. Citation Format: Ryan Ramphul, Jooyeon Lee, Yanchen Liu, Yixiao Chen, Lorna Haughton. McNeill, Karen Basen-Engquist, Ruth Rechis. Persistent poverty and geographic disparities in colorectal cancer risk: A Bayesian spatial analysis in Texas [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B004.