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Examining the Direct and Indirect Effects of Socioeconomic Status on Colorectal Cancer Using Structural Equation
Jing Zhao1,2, Keming Zhang3, Yun Zhu4,5
1Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
Socioeconomic status (SES) significantly impacts colorectal cancer (CRC) risk, both directly and indirectly through lifestyle factors like diet and smoking. Lower SES is associated with higher CRC risk, highlighting the need for targeted interventions.
Area of Science:
- Oncology
- Epidemiology
- Public Health
Background:
- Socioeconomic status (SES) is a known determinant of health outcomes.
- The complex interplay between SES and colorectal cancer (CRC) risk requires further elucidation.
- Understanding these pathways is crucial for developing effective prevention strategies.
Purpose of the Study:
- To investigate the direct and indirect effects of SES on CRC risk.
- To identify mediating factors in the relationship between SES and CRC.
- To quantify the influence of SES on CRC through various pathways.
Main Methods:
- A case-control study was conducted with 488 CRC cases and 651 controls.
- Structural equation modeling was employed to analyze the data.
- SES was assessed using education, income, and resident region.
Main Results:
- Lower SES was directly associated with increased CRC risk (OR=0.89).
- Indirect effects of SES on CRC were observed through processed meat intake, vegetable intake, CRC screening uptake, and smoking.
- Factors like age, processed meat intake, lack of screening, smoking, and family history were also significantly associated with CRC risk.
Conclusions:
- SES exerts both direct and indirect influences on colorectal cancer risk.
- Lifestyle factors and healthcare access mediate the relationship between SES and CRC.
- Interventions addressing SES disparities may help reduce the burden of colorectal cancer.
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