ArticleBMC public health2008
Geographic variation and effect of area-level poverty rate on colorectal cancer screening.
Article in BMC public health, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
46 citing papers in PubMed, 2 syntheses or guidelines pooled it, 71 citations in OpenAlex.
- Multilevel factors influencing colorectal cancer screening adherence: A systematic literature review.PloS one · 2026Pooled it
- Body mass index and colon cancer screening: a systematic review and meta-analysis.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2012Pooled it
- Neighborhood effects in a behavioral randomized controlled trial.Health & place · 2014Trial
- Physicians, clinics, and neighborhoods: multiple levels of influence on colorectal cancer screening.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2014Trial
- Protocol paper for an implementation science approach to promoting colorectal cancer screening in Federally Qualified Health Center Clinics: A stepped-wedge, multilevel intervention trial.Contemporary clinical trials · 2026Article
- Outcomes Among Patients With Colon Cancer Living in Neighborhoods With Persistent Poverty.JAMA network open · 2026Article
- Neighborhood level socioeconomic disparities are associated with reduced colorectal cancer survival.Scientific reports · 2025Article
- Outcomes for Medicaid Patients with Colorectal Cancer Are Improved in Affluent Neighborhoods, but Disparities Persist.Cancers · 2025Article
- Individual and geospatial factors associated with receipt of colorectal cancer screening: a state-wide mixed-level analysis.Family medicine and community health · 2024Article
- Geospatial analysis and participant characteristics associated with colorectal cancer screening participation in Alberta, Canada: a population-based cross-sectional study.BMC health services research · 2023Article
- Structural Racism, Lifestyle Behaviors, and Obesity-related Cancers among Black and Hispanic/Latino Adults in the United States: A Narrative Review.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2023Review
- The impact of neighborhood disadvantage on colorectal cancer screening among African Americans in Chicago.Preventive medicine reports · 2023Article
- Evaluating and Improving Cancer Screening Process Quality in a Multilevel Context: The PROSPR II Consortium Design and Research Agenda.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2022Article
- Eviction Moratoria Expiration and COVID-19 Infection Risk Across Strata of Health and Socioeconomic Status in the United States.JAMA network open · 2021Article
- Observational
- Randomized, wait-list-controlled pilot study of app-delivered mindfulness for patients reporting chronic pain.Pain reports · 2021Article
- An examination between census tract unhealthy food availability and colorectal cancer incidence.Cancer epidemiology · 2020Article
- Causes of Socioeconomic Disparities in Colorectal Cancer and Intervention Framework and Strategies.Gastroenterology · 2020Review
- Utilization of Census Tract-Based Neighborhood Poverty Rates to Predict Non-adherence to Screening Colonoscopy.Digestive diseases and sciences · 2019Observational
- Area-level income disparities in colorectal screening in Canada: evidence to inform future surveillance.Current oncology (Toronto, Ont.) · 2019Article
Corrections and comments
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Authors and funding
3 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundWith a secular trend of increasing colorectal cancer (CRC) screening, concerns about disparities in CRC screening also have been rising. It is unclear if CRC screening varies geographically, if area-level poverty rate affects CRC screening, and if individual-level characteristics mediate the area-level effects on CRC screening.
methodsUsing 2006 Missouri Behavioral Risk Factor Surveillance System (BRFSS) data, a multilevel study was conducted to examine geographic variation and the effect of area-level poverty rate on CRC screening use among persons age 50 or older. Individuals were nested within ZIP codes (ZIP5 areas), which in turn, were nested within aggregations of ZIP codes (ZIP3 areas). Six groups of individual-level covariates were considered as potential mediators.
resultsAn estimated 51.8% of Missourians aged 50 or older adhered to CRC screening recommendations. Nearly 15% of the total variation in CRC screening lay between ZIP5 areas. Persons residing in ZIP5 areas with > or = 10% of poverty rate had lower odds of CRC screening use than those residing in ZIP5 areas with <10% poverty rate (unadjusted odds ratio [OR], 0.69; 95% confidence interval [95% CI], 0.58-0.81; adjusted OR, 0.81; 95% CI, 0.67-0.98). Persons who resided in ZIP3 areas with > or = 20% poverty rate also had lower odds of following CRC screening guidelines than those residing in ZIP3 areas with <20% poverty rate (unadjusted OR, 0.66; 95% CI, 0.52-0.83; adjusted OR, 0.64; 95% CI, 0.50-0.83). Obesity, history of depression/anxiety and access to care were associated with CRC screening, but did not mediate the effect of area-level poverty on CRC screening.
conclusionLarge geographic variation of CRC screening exists in Missouri. Area-level poverty rate, independent of individual-level characteristics, is a significant predictor of CRC screening, but it only explains a small portion of the geographic heterogeneity of CRC screening. Individual-level factors we examined do not mediate the effect of the area-level poverty rate on CRC screening. Future studies should identify other area- and individual-level characteristics associated with CRC screening in Missouri.
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