Association of social deprivation and colon cancer mortality: A population-based analysis.
Authors: Mosffa Ullah, Jorge Rodriguez Vazquez, Ahmed Bashir Sukhera, Merry Mathew, Gloria Erazo, Ooreoluwa Fasola, John Garza, Asley Sanchez
Journal: Journal of Clinical Oncology (2025)

25 Background: Colon cancer mortality is largely influenced by social factors, with higher rates seen in deprived areas. The Social Deprivation Index (SDI) measures factors like poverty, education, and unemployment, which have been linked to poor health outcomes. This study examines the relationship between county level social deprivation and colon cancer mortality in Texas. Methods: We conducted a population-based cohort study of colon cancer deaths in Texas. We queried the National Cancer Institute Surveillance, Epidemiology and End Results Program for county level colon cancer deaths in Texas over the most recent available year, 2021. We calculated age-adjusted mortality rates (AAMRs) per 100,000 population using the direct standardization method based on the age group weights from the 2000 standard US population. Confidence intervals for AAMR were derived by estimating the standard error as the AAMR divided by square root of number of mortalities. The SDI by county was linked to mortality rate using Federal Information Processing Standards (FIPS) codes. The significance of the difference between two AAMR was evaluated by determining if the intersection of 95% confidence intervals was empty. The association between SDI and AAMR was tested using both unweighted and weighted Spearman correlation with county population as weight. Results are reported and Spearman correlation and 95% confidence interval (ρ [95% CI]). Sensitivity analysis was performed by considering only the individual components of the SDI. Subgroup analyses included age group, sex, urban counties, rural counties, and race/ethnicity groups. Results: A total of 3,800 colon cancer mortalities were identified in 2023. The statewide AAMR was 12.5 (95% CI 12.1 to 12.9). Out of 254 counties, 29 (11.4%) had an SDI ≤ 25, 61 (24.0%) had 26 ≤ SDI ≤ 50, 87 (34.3%) had SDI 51 ≤ SDI ≤ 75, and 77 (30.3%) had 76 ≤ SDI ≤ 100. Total population in counties with SDI ≥ 76 was 15,106,726 (51.1%) with AAMR 12.959 (12.379 to 13.538). In contrast, the population in counties with SDI ≤ 25 was 4,771,473 (16.1%) with significantly lower mortality (AAMR 9.752 [95% CI 8.879 to 10.625]). The population weighted Spearman correlation between county level SDI and AAMR was positive (ρ = 0.339 [95% CI 0.209 – 0.514]). The unweighted Spearman correlation between county level SDI and AAMR was also positive (ρ = 0.178 [95% CI 0.089 – 0.238]). Households with no vehicle, poverty, and unemployment were most correlated with AAMR while renter occupied housing had no association. The correlation of county level SDI and AAMR were similar for rural counties, urban counties, males, females, Whites, Hispanics and Blacks. Conclusions: This study reveals a significant positive correlation between higher SDI and increased colon cancer mortality at the county level in Texas. The findings highlight the need for targeted public health interventions in deprived areas to reduce mortality and address disparities.