ArticleResearch square2026
Long-Term Poverty, Rurality, and Geographic Disparities in Colorectal Cancer: A Spatial Analysis in Texas.
Article in Research square, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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8 authors.
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Abstract
Purpose: Colorectal cancer (CRC) remains a leading cause of cancer morbidity and mortality in the United States and showed substantial geographic variation. Socioeconomically disadvantaged communities experience elevated CRC incidence, yet few studies have analyzed multi-decade poverty measures for long-term structural disadvantage. Methods: We analyzed CRC incidence from 2017-2021 across Texas using Texas Cancer Registry data. Age-sex-race/ethnicity standardized cases were incorporated as offsets in Bayesian spatial models to generate tract-level posterior mean relative risks. We evaluated four tract-level poverty measures (high poverty in 2019; persistent poverty since 1990; enduring poverty since 1980 and 1970), Rural-Urban Commuting Area (RUCA) classifications, and CRC screening rates among adults aged 50-75 years. Results: Long-term poverty and rurality were independently associated with elevated CRC risk. Compared with urban tracts, micropolitan and rural tracts had 7-8% higher risks. Poverty measures defined over longer durations showed stronger associations with CRC incidence: high poverty in 2017-2021 (RR = 1.04, 95% CrI: 1.01-1.07), persistent poverty since 1990 (RR = 1.04, 1.00-1.08), enduring poverty since 1980 (RR = 1.06, 1.01-1.11), and enduring poverty since 1970 (RR = 1.09, 1.04-1.15). Higher tract-level CRC screening prevalence was modestly associated with lower CRC incidence (RR per 1% increase = 0.99). Conclusion: Long-term poverty and rural residence were associated with elevated CRC risk in Texas, even after adjusting for screening prevalence. Multi-decade poverty measures and updated RUCA classifications identified geographic disparities not captured by single-year poverty indicators and supported geographically targeted screening, prevention, and resource allocation efforts.
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