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Long-Term Poverty, Rurality, and Geographic Disparities in Colorectal Cancer: A Spatial Analysis in Texas.

Ryan Ramphul1, Tracey Farrigan2, Yixiao Chen1

  • 1The University of Texas Health Science Center at Houston.

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|May 7, 2026
PubMed
Summary
This summary is machine-generated.

Long-term poverty and rural residence are linked to higher colorectal cancer (CRC) risk in Texas. Understanding these disparities can guide targeted screening and prevention efforts for vulnerable populations.

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Area of Science:

  • Epidemiology
  • Public Health
  • Cancer Research

Background:

  • Colorectal cancer (CRC) is a significant cause of cancer mortality in the US, with notable geographic variations.
  • Socioeconomically disadvantaged areas exhibit higher CRC incidence, yet long-term structural disadvantage is understudied.
  • Few studies have analyzed multi-decade poverty measures to understand persistent socioeconomic disadvantage and its link to CRC.

Purpose of the Study:

  • To analyze colorectal cancer (CRC) incidence in Texas from 2017-2021.
  • To evaluate the association between long-term poverty measures, rurality, and CRC risk.
  • To assess the impact of CRC screening rates on CRC incidence across different geographic areas.

Main Methods:

  • Utilized Texas Cancer Registry data for CRC incidence from 2017-2021.
  • Employed Bayesian spatial models with age-sex-race/ethnicity standardized cases to calculate tract-level relative risks.
  • Assessed four tract-level poverty measures (2019, persistent since 1990, enduring since 1980/1970), Rural-Urban Commuting Area (RUCA) classifications, and CRC screening rates.

Main Results:

  • Long-term poverty and rurality were independently associated with increased CRC risk.
  • Micropolitan and rural tracts showed 7-8% higher CRC risks compared to urban tracts.
  • Poverty measures spanning longer durations (e.g., enduring since 1970) demonstrated stronger associations with elevated CRC incidence.

Conclusions:

  • Persistent poverty and rural residence are significant factors associated with elevated CRC risk in Texas, independent of screening rates.
  • Multi-decade poverty indicators and updated RUCA classifications reveal geographic disparities missed by single-year measures.
  • Findings support targeted screening, prevention, and resource allocation strategies for high-risk geographic areas.