Examination Date
5-5-2023
Degree
Dissertation
Degree Program
Epidemiology
Examination Committee
Ariane Rung, PhD; Edward Trapido, PhD; Mei-Chin Hsieh, PhD; Edward S. Peters, DMD; Lee S. McDaniel, PhD; Adrienne Katner, DEnv
Abstract
Colorectal Cancer (CRC) is a major public health concern, ranking third in cancer incidence and deaths in the US. It is influenced by environmental factors, making their identification vital for targeted interventions in high-risk populations. Incidence rates are rising in rural areas compared to non-rural. Additionally, there's a lack of examination of simultaneous environmental exposures. Combining risky and protective exposures can significantly influence outcomes, necessitating a better understanding of their combined impact on CRC prevention and control efforts. To address this gap, this study aimed to investigate the neighborhood and area effects of multidimensional environmental factors on CRC.
In the first aim of the study, we conducted an ecological study to analyze the influence of environmental quality, encompassing air, land, water, sociodemographic, and built environment factors, on age-adjusted CRC incidence and mortality rates, as well as their disparities between urban and rural US counties. Our findings revealed that environmental quality, particularly in sociodemographic and built environment aspects, served as a robust predictor of CRC incidence, mortality rates, and their urban-rural disparities.
In the second aim, we examined the role of area deprivation on CRC risk in terms of early-onset, late-stage diagnosis, treatment received, and overall survivorship among CRC cases in Louisiana. The results indicated that higher neighborhood deprivation levels were associated with increased overall and early-onset CRC incidence and more advanced-stage CRC at diagnosis.
In the third aim, we identified specific built environment archetypes in Louisiana using LCA, which included commercial, residential, satellite, and suburban neighborhoods. Living in residential neighborhoods was linked to a higher risk of advanced-stage CRC diagnosis and a higher likelihood of receiving surgery, while it was associated with a lower risk of cancer-related death compared to commercial neighborhood archetype.
The findings of this study contribute to a better understanding of the comprehensive impact of multidimensional area-based environmental factors on colorectal cancer. By identifying neighborhood and area effects of environmental risk factors, our research provides valuable insights for health-related policies and targeted interventions aimed at improving population health.
Recommended Citation
Li, Tingting, "The Neighborhood and Area Effects of Environmental Factors on Colorectal Cancer: Urban-rural disparities, Incidence, Diagnosis, Treatment, and Survival" (2023). School of Public Health. 8.
https://digitalscholar.lsuhsc.edu/etd_sph/8
Dissertation Report (T. Li) May 2023