Applying Geographic and Demographic Data to Explore Colorectal Cancer Risk Among Rural Texas Counties

BackgroundRural areas of Texas face considerable rates of and risk factors for colorectal cancer (CRC), but limited identification hinders effective intervention. Screening and treatment are impaired by logistical barriers, economic barriers, and lack of baseline data.Combining incidence, socio-economic, and geographic data could highlight counties with multiple risk factors and low levels of surveillance, facilitating further investigation.MethodsCRC incidence, late-stage disease incidence, percentage of residents up-to-date (UTD) with guideline-directed screening, percentage of uninsured residents, and undocumented CRC incidence (insufficient volume of recorded cases to establish incidence) from the National Cancer Institute were accessed for all 254 Texas counties. Counties were considered to have an enhanced factor if disease incidence or the percentage of residents with a given variable was greater or less than the state average.ResultsRural counties (baseline: 66%, total number of counties n = 254) were over-represented among counties with more uninsured residents (80%, n = 138). On consideration of multiple risk factors, rural counties were over-represented among counties with fewer residents UTD on screening and an elevated percentage of uninsured residents (74%, n = 69), and those with elevated CRC incidence and percentage of uninsured residents (72%, n = 29). Rural counties were over-represented among those with undocumented CRC incidence (85%, n = 60), and those with undocumented incidence and an elevated percentage of uninsured residents (90%, n = 30) or fewer residents UTD with screening (86%, n = 36).DiscussionRural Texas communities are at risk of undetected CRC. Limited data hinders interventions, but utilizing available data could help identify communities warranting further investigation and support.