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Methodology

Abstract

Introduction

Results

Discussion and Conclusion

References

American Cancer Society. (2020, June 29). Colorectal cancer information: Understanding colorectal cancer. American Cancer Society. Retrieved July 11, 2022, from https://www.cancer.org/cancer/colon-rectal-cancer

Asgary R, Garland V, Jakubowski A, Sckell B. Colorectal cancer screening among the homeless population of New York City shelter-based clinics. Am J Public Health. 2014 Jul;104(7):1307-13. doi: 10.2105/AJPH.2013.301792. Epub 2014 May 15. PMID: 24832144; PMCID: PMC4056228.

Centers for Disease Control and Prevention. (2022, February 17). What is colorectal cancer? Centers for Disease Control and Prevention. Retrieved July 11, 2022, from https://www.cdc.gov/cancer/colorectal/basic_info/what-is-colorectal-cancer.htm

Doubeni CA, Laiyemo AO, Major JM, Schootman M, Lian M, Park Y, Graubard BI, Hollenbeck AR, Sinha R. Socioeconomic status and the risk of colorectal cancer: an analysis of more than a half million adults in the National Institutes of Health-AARP Diet and Health Study. Cancer. 2012 Jul 15;118(14):3636-44. doi: 10.1002/cncr.26677. Epub 2012 Jan 3. Erratum in: Cancer. 2013 Jan 15;119(2):467-9. PMID: 22898918; PMCID: PMC3422782.

Hur J, Otegbeye E, Joh H, et al Sugar-sweetened beverage intake in adulthood and adolescence and risk of early-onset colorectal cancer among womenGut 2021;70:2330-2336.

Hwang AE, Tsai KY, Huynh J, Liu L, Lenz H-J, Deapen D. Cancer in Los Angeles County: Colon Cancer Incidence, Mortality and Survival 2000-2017. Los Angeles Cancer Surveillance Program, Norris Comprehensive Cancer Center, University of Southern California, 2020.

Johnson CM, Wei C, Ensor JE, Smolenski DJ, Amos CI, Levin B, Berry DA. Meta-analyses of colorectal cancer risk factors. Cancer Causes Control. 2013 Jun;24(6):1207-22. doi: 10.1007/s10552-013-0201-5. Epub 2013 Apr 6. PMID: 23563998; PMCID: PMC4161278.

Maciosek MV, Solberg LI, Coffield AB, Edwards NM, Goodman MJ. Colorectal cancer screening: health impact and cost effectiveness. Am J Prev Med. 2006;31(1):80–89.

Park SY, Wilkens LR, Setiawan VW, Monroe KR, Haiman CA, Le Marchand L. Alcohol Intake and Colorectal Cancer Risk in the Multiethnic Cohort Study. Am J Epidemiol. 2019 Jan 1;188(1):67-76. doi: 10.1093/aje/kwy208. PMID: 30239578; PMCID: PMC6321802.

There has been limited research on colorectal cancer (CRC) risk factors specifically for differences between Service Planning Area (SPA) 6, a part of LA County, compared to LA County as a whole. The aim of this study is to examine listed biological, socioeconomic, and behavioral CRC risk factors that contribute to a difference in CRC death rates in SPA 6 compared to LA County. This research is vital because a majority of SPA 6 consists of minority populations and this can be a step toward alleviating CRC disparities. Hypothesis: There are significant differences between CRC death rates in SPA 6 and LA County overall due to increased risks in SPA 6.This cross-sectional study used secondary data from the LA County of Public Health Report (2017) and Supplement to Health Assessment Report: SPA 6 (2014) to compare data and create graphs using statistical analysis. Through literature review, notable CRC risk factors were examined. Inclusion: adults (age>18) who reside in LA County or SPA 6. There were significant differences in socioeconomic and behavioral risk factors between SPA 6 and LA County. Socioeconomic: housing instability (9.9% vs. 4.8%, p<0.05) and adults whose neighborhoods are without paths, parks, playgrounds, or sports fields (21.7% vs 15.2%, p<0.05); Behavioral: Obesity (34.1% vs. 23.5%, p<0.05), Low fruit/vegetable consumption (9.6% vs. 14.7%, p<0.05), and High soda/sweetened drink consumption (41.9% vs 31.4%, p<0.05). Biological factors were not analyzed due to limitations. The results demonstrated that some behavioral and socioeconomic risks correlated with CRC are significantly more prevalent in SPA 6 compared to LA County overall. Increased CRC risk factors may be linked to a higher CRC death rate in SPA 6.

From Key Indicators of Health by

Los Angeles County Department of Public Health, 2017. (p. 4)

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The objective of this study is to examine these listed factors and how these contribute to CRC incidence rates and mortality rates in Service Planning Area (SPA) 6 compared to LA County.

SPA 6 is a subdivision of LA County serving the residents of Athens, Compton, Crenshaw, Florence, Hyde Park, Lynwood, Paramount, and Watts.

Examining Biological, Socioeconomic, and Behavioral Colorectal Cancer

Risk Factors in SPA 6 vs. LA County

Shaun Thomas, Academy of the Canyons, Santa Clarita, CA

Mentor: Juanita Booker-Vaughns, Ed.D.

Charles R. Drew University of Medicine and Science, Los Angeles, CA

Acknowledgements

Objective

Colorectal cancer (CRC) is the third most commonly diagnosed cancer in Los Angeles (LA) County, the most populous in the United States, with about 2700 newly diagnosed people in the county annually (Hwang et al., 2020). CRC refers to an abnormal growth of cells that starts in the colon or the rectal area (Centers for Disease Control and Prevention [CDC], 2022). The colon refers to the part of the large intestine that includes the ascending colon, transverse colon, descending colon, and sigmoid colon. The rectum serves as the path between the colon and the anus.

A meta-analysis of CRC risk factors concludes that people with Inflammatory Bowel Disease (IBD) and those who have a first-degree relative who has CRC are substantially more likely to get CRC.

This analysis also goes on to conclude that factors like increased body mass index (BMI), red meat intake, sedentary behavior, cigarette smoking, and low fruit/vegetable consumption, were moderately associated with an increased risk of developing CRC (Johnson et al., 2013).

After adjusting for age, sex, and race/ethnicity, a study in 2019 found that alcohol use >15.0g/day was linked to an increased risk of colorectal cancer (Rogers et al., 2019).
CRC screening is accepted as the standard of treatment as it decreases morbidity and death by 60% (Maciosek et al., 2006).

When detected early, CRC is simpler to treat and can even be prevented with routine screening (American Cancer Society 2020).

A study about socioeconomic status and the risk of CRC established that even after controlling for other risk variables, CRC incidence was highest in those with low education levels or those that resided in low-SES neighborhoods in comparison to the highest-SES (Doubeni et al., 2013).
In a CRC screening study among the homeless population, findings concluded that people with stable housing were more likely to get screening compared to the homeless (Asgary et al., 2014).
Recent studies suggest, such as one that suggests that higher sugar-sweetened beverage consumption can increase the risk of early-onset colorectal cancer among women (Hur et al., 2020).

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A majority of SPA 6’s population is Hispanic and African American, constituting 95.6% of the area’s population. When examining the socioeconomic factors, housing instability in SPA 6 was significantly greater than housing instability in LA County. SPA 6 also had a significantly higher percentage of adults whose neighborhoods without walking paths, parks, playgrounds, or sports fields than neighborhoods in LA County. Other socioeconomic factors, such as low income below the FPL, low education, and decreased access to healthcare were higher in SPA 6 than in LA County. Among the behavioral factors analyzed, poor diet seemed to be the most notable with p<0.05 for 2 of 3 factors (increased soda/sweetened beverage consumption and low vegetable/fruit consumption). Another behavioral factor that was significantly higher in SPA 6 was obesity (34.1% vs 23.5%). Poor diet and obesity are directly linked to increased risk for CRC, per multiple studies listed. Excessive alcohol consumption and smoking were lower in SPA 6 than in LA County overall.

The percentage of SPA 6 adults who get the recommended amount of exercise in a week is less than the percentage of LA County adults who get the recommended amount of exercise in a week. Maybe, this could be linked to the lower percentage of adults whose neighborhoods are without walking paths, parks, playgrounds, or sports fields. The percentage of adults who are current with colorectal screening is 7% lower in SPA 6 than adults in LA County, while the CRC death rate is significantly higher in SPA 6, overall supporting the listed studies’ findings about CRC screening’s negative relationship with CRC’s death rate. Biological factors were not analyzed as such data were not available for SPAs in LA County. Future studies could incorporate data on biological factors that increase the risk for CRC. Understanding the impact of these risk factors and implementing measures to alleviate disparities in the SPA 6 population can decrease the morbidity and mortality related to CRC.�

Cross sectional research study using secondary data from Key Indicators of Health by Service Planning Area from the LA County of Public Health Report (2017) to compare the risk factors of CRC among the SPA 6 population to that of LA County. Supplement to Health Assessment Report: SPA 6 was also used for secondary data. Inclusion Criteria: Adults (age>18) that live in LA County or SPA 6.

Risk Factors

Biological

Socioeconomic

Behavioral

1) CRC Risk factors (listed in introduction) examined and classified into groups.

2) Cross sectional research study using

secondary data from Key Indicators of Health Report (2017) to gather data.

3) Supplement to Health Assessment Report: SPA 6 (2014) for extra data; graphs and charts were created to compare data.

This project is supported by Grant 2020244 from the Doris Duke Charitable Foundation to Charles R. Drew University of Medicine and Science.
Thank you to Dr. Booker-Vaughns for helping me along the way and my parents for supporting me.

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