Neighborhood socioeconomic status and behavioral pathways to risks of colon and rectal cancer in women
Open Access
- 23 August 2010
- Vol. 116 (17), 4187-4196
- https://doi.org/10.1002/cncr.25195
Abstract
BACKGROUND: Neighborhood amenities and resources plausibly determine individual modifiable risk factors for colon and rectal cancer. Evidence on the associations between neighborhood socioeconomic status (SES) and incident colon and rectal cancer is limited. METHODS: The authors analyzed a prospective cohort of 111,129 women in the Nurses' Health Study with no history of cancer in 1986 followed to 2006. Neighborhood SES was based on Census‐derived characteristics of block groups of residence. Cox models were used to estimate the multivariate‐adjusted associations between neighborhood SES and incident colon and rectal cancer, and to examine for effect modification. For significant associations, path models were estimated with behavioral risk factors included as potential mediators. RESULTS: Neighborhood SES was unassociated with colon cancer among all women. However, among women with college or greater education, higher neighborhood SES was inversely related to colon cancer (P for trend = .01; P for interaction between neighborhood SES and education = .03). Path analysis suggested mediation by red meat intakes and body mass index (BMI). Higher neighborhood SES was inversely related to rectal cancer among all women (relative risk in highest quintile, 0.64; 95% confidence interval, 0.44‐0.93; P for trend = .08). Path analysis was consistent with mediation by multivitamin use and BMI. CONCLUSIONS: These findings suggest that living in a higher‐SES neighborhood may protect against rectal cancer in women and colon cancer in higher‐educated women, mediated by selected behavioral risk factors. Risk factor differences between colon and rectal cancer may account for discrepancies in estimated neighborhood effects by cancer site. Cancer 2010. © 2010 American Cancer Society.Keywords
This publication has 28 references indexed in Scilit:
- Social inequalities in stage at diagnosis of rectal but not in colonic cancer: a nationwide studyBritish Journal of Cancer, 2008
- Effects of neighbourhood socioeconomic status and convenience store concentration on individual level smokingJournal of Epidemiology and Community Health, 2005
- Neighbourhood influences on health in Montréal, CanadaSocial Science & Medicine, 2004
- Comparison of risk factors for colon and rectal cancerInternational Journal of Cancer, 2003
- Are there two sides to colorectal cancer?International Journal of Cancer, 2002
- Neighbourhood differences in diet: the Atherosclerosis Risk in Communities (ARIC) StudyJournal of Epidemiology and Community Health, 1999
- Disadvantage and male cancer incidence and mortality in New South Wales 1985–1993Social Science & Medicine, 1997
- Socioeconomic circumstances and the risk of bowel cancer in Northern Ireland.Journal of Epidemiology and Community Health, 1996
- Reproducibility and Validity of a Self-Administered Physical Activity QuestionnaireInternational Journal of Epidemiology, 1994
- Validity of Self-Reported Waist and Hip Circumferences in Men and WomenEpidemiology, 1990