Demographics, distance to gastrointestinal specialists, and social deprivation are associated with advanced stage of gastrointestinal cancer diagnosis.

Background: Gastrointestinal (GI) luminal cancers can be detected at early stages by endoscopic procedures. Place-based factors, such as social deprivation and distance to specialist care, are under-investigated with regard to the stage of diagnosis. Methods: This was a retrospective cohort study among persons ≥18 years of age in the Florida Cancer Data System, a population-based cancer incidence registry. We included persons diagnosed with esophageal cancer, gastric canceror colorectal cancer, with at least 1 measure of geographic location during the period January 1, 1981, to December 31, 2016. Multivariate multinomial logistic regression was used to identify factors associated with the stage of diagnosis, including social deprivation and proximity to GI care. Results: Among 379,054 persons, the median age was 71 years, and 54% were male. Distant stage disease was significantly less likely than local stage in those of non-Hispanic/Latino ethnicity (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.89-0.94, P<0.001). Distant disease was more likely in African Americans (OR 1.30, 95%CI 1.26-1.34) and Asians (OR 1.41, 95%CI 1.27-1.56, P<0.001), with each 5-min increase in travel time to specialists, (OR 1.02, 95%CI 1.01-1.02, P<0.001), and with each 10-point increase in Social Deprivation Index (OR 1.01, 95%CI 1.01-1.02, P<0.001). Conclusions: A greater distance from care and living in areas with increased deprivation are associated with an advanced stage of diagnosis and should be recipients of policy-driven efforts to improve access to care. That the strongest risk factors include minority race and ethnicity underlines the complexity of healthcare disparities.

Increasing Rates of Pancreatic and Hepatocellular Cancers Parallel Increasing Obesity Rates.

OBJECTIVES: Gastrointestinal (GI) cancers are now the second leading cause of cancer death in the United States, and six are convincingly associated with obesity. We interrogate the association of a state's obesity prevalence with cancer incidence. METHODS: We use data from US Cancer Statistics for each of the 6 cancers of interest from 2011 to 2018. Age-adjusted incidences were calculated, and the Behavioral Risk Factor Surveillance System was used to identify prevalence of obesity in each state. A generalized estimating equation model was used to relate the rate of cancer with the rate of obesity. RESULTS: Increased state-level prevalence of obesity was significantly associated with increasing state-level incidence of pancreatic and hepatocellular cancers. The rate of colorectal cancer was not associated with increasing obesity in 2011-2014 but from 2015 to 2018 was inversely associated with increasing rates of obesity. State-level prevalence of obesity was not associated with esophageal, gastric, or gallbladder cancers. CONCLUSIONS: Weight management interventions may reduce risk of pancreatic and hepatocellular cancers.