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Investigating Cancer Inequalities in Urbanizing Texas with Plausible Reasoning
1O'Donnell School of Public Health, University of Texas Southwestern Medical Center, USA.
Annals of the American Association of Geographers
|April 10, 2025
Summary
This study reveals increasing spatial inequalities in colorectal cancer (CRC) incidence, driven by urbanization and unequal access to screening colonoscopy. Plausible reasoning (PR) offers a framework for analyzing these complex health disparities.
Area of Science:
- Geographical methodology
- Epidemiology
- Public Health
Background:
- Existing realist and reflexive frameworks for scientific inquiry.
- Need for robust methodologies to analyze health disparities.
- Understanding the racial disparity in colorectal cancer (CRC) burden.
Purpose of the Study:
- To present an epistemology of plausible reasoning (PR) as a complementary framework for scientific research.
- To apply PR principles to investigate the causes of racial disparities in CRC burden in Houston and Dallas-Fort Worth.
- To analyze geographic and social changes impacting CRC burden between 1999 and 2019.
Main Methods:
- Introduction of PR's theory of evidence, based on Harold Jeffreys and George Pólya.
- Extrapolation of PR principles for nonexperimental study designs.
- Structuring an investigation using empirical questions on racial ghettoization, urbanization, and cancer inequalities.
Main Results:
- Emergence of significant class-related inequality in CRC incidence.
- Rise of aggregate racial disparities in CRC incidence outside historically marginalized areas.
- Overall intensification of spatial inequality in CRC burden from 1999 to 2019.
Conclusions:
- Changes in CRC burden are attributed to the uneven dissemination of screening colonoscopy amid polarizing urbanization.
- Fundamental cause theory and critical urban studies inform the understanding of these health inequalities.
- PR methodology effectively incorporates macrostructures and political economy into spatial health data analysis.
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