Sociocultural Factors, Access to Healthcare, and Lifestyle: Multifactorial Indicators in Association with Colorectal Cancer Risk.

Shaneda Warren Andersen, Wei Zheng, Mark Steinwandel, Harvey J Murff, Loren Lipworth, William J Blot

Black Americans of low SES have higher colorectal cancer (CRC) incidence than other groups in the US. However, much of the research that identifies CRC risk factors is conducted in cohorts of high SES and non-Hispanic white participants. Adults participants of the Southern Community Cohort Study (N=75,182) were followed for a median of 12.25 years where 742 incident CRCs were identified. The majority of the cohort are non-Hispanic white or Black and have low household income. Cox models were used to estimate hazard ratios (HRs) for CRC incidence associated with sociocultural factors, access to and use of healthcare, and healthy lifestyle scores to represent healthy eating, alcohol intake, smoking and physical activity. The association between Black race and CRC was consistent and not diminished by accounting for SES, access to healthcare or healthy lifestyle (HR=1.34; 95%CI:1.10,1.63). CRC screening was a strong, risk reduction factor for CRC (HR=0.65; 95%CI:0.55,0.78), and among CRC-screened, Black race was not associated with risk. Participants with >= high school education were at lower CRC risk (HR=0.81; 95%CI:0.67,0.98). Income and neighborhood-level SES were not strongly associated with CRC risk. Whereas individual health behaviors were not associated with risk, participants that reported adhering to >=3 health behaviors had a 19% (95%CI:1%,34%) decreased CRC risk compared to participants that reported =<1 behaviors. The association was consistent in fully-adjusted models, although HRs were no longer significant. CRC screening, education, and a lifestyle that includes healthy behaviors lowers CRC risk. Racial disparities in CRC risk may be diminished by CRC screening.