Cancer of the Colorectum in Maine, 1995-1998: Determinants of Stage at Diagnosis in a Rural State

Context: Despite screening for colorectal cancer, mortality in the United States remains substantial. In northern New England, little is known about predictors of stage at diagnosis, an important determinant of survival and mortality. Purpose: The objective of this study was to identify predictors of late stage at diagnosis for colorectal cancer in a rural state with a predominantly white population and a large Franco-American minority. Methods: Incident cases from 1995-1998 were obtained from the Maine Cancer Registry. Individual-level variables (age, sex, race, French ethnicity by surname, and payer) and contextual/town-level variables (socioeconomic status, population density, Franco ancestry proportion, distance to health care, and weather) were modeled with multiple logistic regression for late stage. Findings: Increasing distance to primary care provider was associated with late stage for colorectal cancer. Compared to patients aged ,85 years, those aged 65-84 years were less likely to be diagnosed late, while those aged 35-49 years were more likely--although not significantly--to have late stage at diagnosis. Associations were not found with socioeconomic variables. Conclusions: The finding regarding distance to primary care may be consistent with studies showing that rurality and distance to care predict reduced utilization of health care services and worse health outcomes. The finding regarding age has implications for the education of younger high-risk patients and their physicians. The absence of positive findings with regard to socioeconomic variables may stem from the uniquely mixed sociodemographic profiles in rural and urban regions of Maine. Further research should refine these and other contextual measures to elucidate effects on rural health and should further evaluate the utility of assigning French ethnicity by surname in order to identify health disparities.