Colorectal Cancer in Idaho November 2, 2006 Chris Johnson, CDRI

Transcription

1 Colorectal Cancer in Idaho November 2, 2006 Chris Johnson, CDRI

2 Colorectal Cancer in Idaho, Fast facts: Colorectal cancer is the second leading cause of cancer death in Idaho and the U.S. It is largely preventable with screening and the removal of pre-cancerous polyps. There is currently no program in Idaho to specifically address awareness, prevention and early detection of colorectal cancer.

3 Colorectal Cancer in Idaho, Presentation includes information on: Risk Factors (BRFSS & YRBSS) Screening (BRFSS) Incidence (CDRI & SEER) Survival (CDRI & SEER) Mortality (CDRI & SEER)

4 Risk Factors - Data Sources YRBSS Youth Risk Behavior Surveillance System School-based health survey of public high school students in Idaho. Conducted by the Idaho Department of Education with assistance from Idaho Division of Health and CDC. BRFSS Behavioral Risk Factor Surveillance System Phone-based health survey of adults aged 18+. Conducted by Idaho Division of Health under cooperative agreement with CDC.

5 Presentation Format Population Prevalence Probability (Odds Ratios) Maps Crude (Population Prevalence) Adjusted (Odds Ratios)

6 Prevalence In epidemiology, the prevalence of a disease or condition is defined as: the total number of persons with the disease/condition in a specified population at a specified time and/or the ratio of the number of cases of the disease/condition to the total population size at a specified time (percentage, rate).

7 Odds Ratio The odds are a way of representing probability, especially familiar for betting. Example: the odds that a single throw of a die will produce a six are 1 to 5, or 1/5. The odds is the ratio of the probability that the event of interest occurs to the probability that it does not. This is often estimated by the ratio of the number of times that the event of interest occurs to the number of times that it does not.

8 Odds Ratio Review Disease Yes No Exposure Yes No Odds of Disease among Exposed = 20/30 =.667 Odds of Disease among non-exposed = 10/100 =.1 Odds Ratio = 6.67 Odds of Exposure among Cases = 20/10 = 2.0 Odds of Exposure among Controls = 30/100 = 0.3 Odds Ratio = 6.67

9 Odds Ratio Review These are the SAME numerical ratios. This property makes the odds ratio a useful indicator of the strength of relationships, for both case-control and cohort studies.

10 Physical Activity: 30+ Min Moderate 5+ Days/Wk or 20+ Min Vigorous 3+ Days/Wk Men and Women Aged 18+ Goal: 65% Percent 95% Confidence Rounded 2005 Number Insuff. # To Reach Overall N Phys Act Interval Population Phys Act Phys Act Goal Yes % 56.3% % 951, , ,000 67,000 Percent 95% Confidence Rounded 2005 Number Insuff. # To Reach Race/Ethnicity N Phys Act Interval Population Phys Act Phys Act Goal Non-Hispanic White % 57.2% % 827, , ,000 50,000 Hispanic % 37.1% % 80,000 37,000 43,000 16,000 Native American % 44.3% % 14,000 8,000 6,000 2,000 Other % 49.2% % 28,000 17,000 11,000 2,000 Percent 95% Confidence Rounded 2005 Number Insuff. # To Reach Age Group N Phys Act Interval Population Phys Act Phys Act Goal % 57.7% % 150,000 97,000 53,000 1, % 56.3% % 173, ,000 68,000 8, % 59.1% % 178, ,000 66,000 4, % 55.5% % 181, ,000 74,000 11, % 48.1% % 128,000 67,000 62,000 17, % 43.3% % 142,000 66,000 76,000 27,000 Percent 95% Confidence Rounded 2005 Number Insuff. # To Reach Sex N Phys Act Interval Population Phys Act Phys Act Goal Male % 57.1% % 478, , ,000 25,000 Female % 54.0% % 473, , ,000 42,000 Percent 95% Confidence Rounded 2005 Number Insuff. # To Reach Health Insurance N Phys Act Interval Population Phys Act Phys Act Goal Yes % 56.8% % 770, , ,000 49,000 No % 49.7% % 176,000 97,000 80,000 18,000 Percent 95% Confidence Rounded 2005 Number Insuff. # To Reach Household Income N Phys Act Interval Population Phys Act Phys Act Goal Less than $15, % 47.2% % 92,000 49,000 43,000 11,000 $15,000 - $24, % 47.6% % 157,000 82,000 75,000 21,000 $25,000 - $34, % 53.3% % 134,000 78,000 56,000 9,000 $35,000 - $49, % 54.9% % 172, ,000 71,000 11,000 $50, % 60.8% % 305, , ,000 4,000 Percent 95% Confidence Rounded 2005 Number Insuff. # To Reach Education N Phys Act Interval Population Phys Act Phys Act Goal Not College Grad % 53.6% % 684, , ,000 63,000 College Grad % 60.7% % 267, ,000 97,000 4,000 Source: 2005 BRFSS data provided by BHPVS, analyzed by CDRI. Note: Estimated 2005 population based on 2005 BRFSS weights. Category totals are not equal due to differential missing data patterns. Population numbers are rounded to the nearest 1,000. Number to screen to reach goal rounded up to nearest 1,000. * In 2005, Idaho ranked 12th among states (1st = best) in the proportion of adults who engaged in moderate or vigorous physical activity for the prescribed durations and frequencies.

11 Physical Activity Men and Women Aged 18+ Aggregated BRFSS Data Results from Multilevel Logistic Regression Modeling Odds Ratios and 95% Confidence Intervals for Fixed Parameters Main Effect OR 95% CI Age, y Sex Male Female 1.00 Race/Ethnicity Non-Hispanic White Hispanic Native American Other 1.00 Health Insurance Yes No 1.00 Household Income Less than $15, $15,000 - $24, $25,000 - $34, $35,000 - $49, $50, Education Not College Grad 1.00 College Grad Year of Survey Variation (on Logit Scale) in Screening Between Counties, Before and After Taking Into Account Individual-Level Covariates, Idaho, Before Adjustment After Percent Change %

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13 Youth Physical Activity By 2010 Increase to 80% the percentage of idaho high school students who accumulate 30 minutes or more per day of moderate physical activity on five or more days of the week or participate in 20 minutes or more of vigorous physical acitivity on three or more days of the week. Source: 2005 Idaho Youth Risk Behavior Survey N % 95% C.I. Total Population* (rounded) Number of Physically Active Youth Number of students needing to increase P.A. to hit target 2005 Idaho total 1, % 70.5% % 66,700 48,691 4,669 Sex Male % 75.1% % 32,300 25, Female % 63.0% % 34,200 23,119 4,241 Ethnicity Hispanic % 61.3% % 7,000 4, White 1, % 71.0% % 50,600 37,242 3,238 Grade 9th % 70.8% % 12,200 9, th % 74.1% % 16,000 12, th % 63.8% % 22,900 15,755 2,565 12th % 61.3% % 15,000 10,305 1,695 *Based on weighted sample values; data were weighted by grade and sex to represent Idaho public school students in grades 9 through 12.

14 Body Mass Index: Neither Overweight Nor Obese (BMI<25.0) Men and Women Aged 18+ Goal: 45% Percent 95% Confidence Rounded 2005 Number Over- # To Reach Overall N OK Weight Interval Population OK Weight Weight Goal Yes % 36.8% % 970, , ,000 62,000 Percent 95% Confidence Rounded 2005 Number Over- # To Reach Race/Ethnicity N OK Weight Interval Population OK Weight Weight Goal Non-Hispanic White % 37.0% % 853, , ,000 53,000 Hispanic % 30.4% % 69,000 28,000 42,000 4,000 Native American % 14.2% % 15,000 4,000 11,000 3,000 Other % 25.3% % 30,000 11,000 19,000 3,000 Percent 95% Confidence Rounded 2005 Number Over- # To Reach Age Group N OK Weight Interval Population OK Weight Weight Goal % 52.1% % 144,000 86,000 59, % 38.1% % 173,000 73, ,000 5, % 30.9% % 180,000 62, ,000 19, % 26.1% % 184,000 54, ,000 30, % 27.4% % 131,000 40,000 91,000 19, % 35.1% % 157,000 60,000 97,000 11,000 Percent 95% Confidence Rounded 2005 Number Over- # To Reach Sex N OK Weight Interval Population OK Weight Weight Goal Male % 26.3% % 492, , ,000 78,000 Female % 46.2% % 478, , ,000 - Percent 95% Confidence Rounded 2005 Number Over- # To Reach Health Insurance N OK Weight Interval Population OK Weight Weight Goal Yes % 35.8% % 794, , ,000 59,000 No % 38.1% % 171,000 74,000 97,000 3,000 Males Percent 95% Confidence Rounded 2005 Number Over- # To Reach Household Income N OK Weight Interval Population OK Weight Weight Goal Less than $15, % 30.2% % 37,000 17,000 21,000 1,000 $15,000 - $24, % 24.7% % 82,000 25,000 56,000 12,000 $25,000 - $34, % 24.3% % 72,000 24,000 48,000 9,000 $35,000 - $49, % 15.8% % 92,000 19,000 73,000 23,000 $50, % 22.4% % 176,000 46, ,000 33,000 Females Percent 95% Confidence Rounded 2005 Number Over- # To Reach Household Income N OK Weight Interval Population OK Weight Weight Goal Less than $15, % 39.1% % 54,000 24,000 30,000 - $15,000 - $24, % 41.4% % 82,000 38,000 44,000 - $25,000 - $34, % 42.5% % 62,000 30,000 32,000 - $35,000 - $49, % 41.3% % 81,000 38,000 43,000 - $50, % 46.5% % 139,000 70,000 69,000 - Source: 2005 BRFSS data provided by BHPVS, analyzed by CDRI. Note: Estimated 2005 population based on 2005 BRFSS weights. Category totals are not equal due to differential missing data patterns. Population numbers are rounded to the nearest 1,000. Numbers to reach goal rounded up to nearest 1,000. * In 2005, Idaho ranked 25th among states (1st = best) in the proportion of adults who were neither overweight nor obese (body mass index < 25.0).

15 Body Mass Index: Neither Overweight Nor Obese (BMI<25.0) Men and Women Aged 18+ Aggregated BRFSS Data Results from Multilevel Logistic Regression Modeling Odds Ratios and 95% Confidence Intervals for Fixed Parameters Main Effect OR 95% CI Age, y Race/Ethnicity Non-Hispanic White Hispanic Native American Other 1.00 Health Insurance Yes No 1.00 Sex and Income M- Less than $15, M- $15,000 - $24, M- $25,000 - $34, M- $35,000 - $49, M- $50, F- Less than $15, F- $15,000 - $24, F- $25,000 - $34, F- $35,000 - $49, F- $50, Education Not College Grad 1.00 College Grad Year of Survey Variation (on Logit Scale) in Screening Between Counties, Before and After Taking Into Account Individual-Level Covariates, Idaho, Before Adjustment After Percent Change %

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17 Colorectal Cancer Screening: Colonoscopy or Sigmoidoscopy Within Previous 5 Years Men and Women Aged 50+ Goal: 50% Percent 95% Confidence Rounded 2004 Number Not # to Screen To Overall N Screened Interval Population Screened Screened Reach Goal Yes % 35.7% % 365, , ,000 44,000 Percent 95% Confidence Rounded 2004 Number Not # to Screen To Age Group N Screened Interval Population Screened Screened Reach Goal % 20.1% % 92,000 22,000 69,000 24, % 32.1% % 124,000 44,000 80,000 18, % 44.4% % 149,000 72,000 77,000 3,000 Percent 95% Confidence Rounded 2004 Number Not # to Screen To Sex N Screened Interval Population Screened Screened Reach Goal Male % 35.6% % 170,000 67, ,000 19,000 Female % 34.0% % 195,000 72, ,000 26,000 Percent 95% Confidence Rounded 2004 Number Not # to Screen To Health Insurance N Screened Interval Population Screened Screened Reach Goal Yes % 38.1% % 331, , ,000 32,000 No % 8.1% % 33,000 4,000 29,000 13,000 Percent 95% Confidence Rounded 2004 Number Not # to Screen To Household Income N Screened Interval Population Screened Screened Reach Goal Less than $15, % 28.1% % 32,000 11,000 21,000 5,000 $15,000 - $24, % 32.2% % 73,000 27,000 46,000 10,000 $25,000 - $34, % 33.9% % 54,000 21,000 33,000 6,000 $35,000 - $49, % 30.5% % 61,000 22,000 39,000 9,000 $50, % 35.0% % 100,000 40,000 61,000 11,000 Percent 95% Confidence Rounded 2004 Number Not # to Screen To Education N Screened Interval Population Screened Screened Reach Goal Not College Grad % 33.9% % 263,000 96, ,000 36,000 College Grad % 37.1% % 102,000 42,000 59,000 9,000 Source: 2004 BRFSS data provided by BHPVS, analyzed by CDRI. Note: Estimated 2004 population based on 2004 BRFSS weights. Category totals are not equal due to differential missing data patterns. Population numbers are rounded to the nearest 1,000. Number to screen to reach goal rounded up to nearest 1,000. * In 2004, Idaho ranked 42nd among states (1st = best) in the proportion of adults aged 50+ who have ever had a sigmoidoscopy or colonoscopy.

18 Colonoscopy or Sigmoidoscopy Within Previous 5 Years Men and Women Aged 50+ Aggregated BRFSS Data Results from Multilevel Logistic Regression Modeling Odds Ratios and 95% Confidence Intervals for Fixed Parameters Main Effect OR 95% CI Age, y Sex Male Female 1.00 Health Insurance Yes No 1.00 Household Income Less than $15, $15,000 - $24, $25,000 - $34, $35,000 - $49, $50, Education Not College Grad 1.00 College Grad Year of Survey Variation (on Logit Scale) in Screening Between Counties, Before and After Taking Into Account Individual-Level Covariates, Idaho, Before Adjustment After Percent Change % Variation (on Logit Scale) in Screening Between Counties, Before and After Taking Into Account County-Level # of Facilities Offering Colonoscopy, Idaho, Before Adjustment After Percent Change %

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20 Colorectal Cancer Screening: Blood Stool Test Within Previous 2 Years Men and Women Aged 50+ Goal: 33% Percent 95% Confidence Rounded 2004 Number Not # to Screen To Overall N Screened Interval Population Screened Screened Reach Goal Yes % 19.9% % 362,000 79, ,000 41,000 Percent 95% Confidence Rounded 2004 Number Not # to Screen To Age Group N Screened Interval Population Screened Screened Reach Goal % 9.7% % 90,000 12,000 78,000 18, % 21.4% % 123,000 30,000 92,000 11, % 21.5% % 149,000 37, ,000 13,000 Percent 95% Confidence Rounded 2004 Number Not # to Screen To Sex N Screened Interval Population Screened Screened Reach Goal Male % 18.0% % 169,000 36, ,000 21,000 Female % 20.0% % 193,000 43, ,000 21,000 Percent 95% Confidence Rounded 2004 Number Not # to Screen To Health Insurance N Screened Interval Population Screened Screened Reach Goal Yes % 20.3% % 328,000 74, ,000 35,000 No % 10.1% % 33,000 5,000 27,000 6,000 Percent 95% Confidence Rounded 2004 Number Not # to Screen To Household Income N Screened Interval Population Screened Screened Reach Goal Less than $15, % 14.6% % 32,000 6,000 26,000 5,000 $15,000 - $24, % 17.8% % 72,000 16,000 56,000 8,000 $25,000 - $34, % 18.2% % 54,000 12,000 41,000 6,000 $35,000 - $49, % 15.1% % 61,000 12,000 49,000 9,000 $50, % 17.9% % 98,000 22,000 77,000 11,000 Percent 95% Confidence Rounded 2004 Number Not # to Screen To Education N Screened Interval Population Screened Screened Reach Goal Not College Grad % 18.5% % 261,000 54, ,000 33,000 College Grad % 20.8% % 100,000 25,000 75,000 8,000 Source: 2004 BRFSS data provided by BHPVS, analyzed by CDRI. Note: Estimated 2004 population based on 2004 BRFSS weights. Category totals are not equal due to differential missing data patterns. Population numbers are rounded to the nearest 1,000. Number to screen to reach goal rounded up to nearest 1,000. * In 2004, Idaho ranked 45th among states (1st = best) in the proportion of adults aged 50+ who had a blood stool test within the previous two years.

21 Blood Stool Test Within Previous 2 Years Men and Women Aged 50+ Aggregated BRFSS Data Results from Multilevel Logistic Regression Modeling Odds Ratios and 95% Confidence Intervals for Fixed Parameters Main Effect OR 95% CI Age, y Sex Male Female 1.00 Health Insurance Yes No 1.00 Household Income Less than $15, $15,000 - $24, $25,000 - $34, $35,000 - $49, $50, Education Not College Grad 1.00 College Grad Year of Survey Variation (on Logit Scale) in Screening Between Counties, Before and After Taking Into Account Individual-Level Covariates, Idaho, Before Adjustment After Percent Change %

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23 Colorectal Cancer in Idaho, , Invasive Cases Numbers of Cases, Age-adjusted and Crude Rates Rates Geography Adjusted Crude Cases Person-Years Health District ,966 Health District ,038 Health District ,379 Health District ,109,708 Health District ,889 Health District ,239 Health District ,201 State of Idaho ,714 4,103,420 SEER Whites ,577 59,360,369 SEER All Races ,022 76,177,809 Rates are per 100,000 person-years. Age-adjusted rates use the 2000 U.S. standard.

24 State Colorectal Cancer Incidence Age-specific Rates < Age Group (in years) All Male Female Rate per 100,000 person-years

25 Colorectal Cancer Stage-specific Age-adjusted Incidence Rates, Late Early SEER 2003 State of Idaho Health District 1 Health District 2 Health District 3 Health District 4 Health District 5 Health District 6 Health District 7 Age-adjusted rate per 100,000

26 Colorectal Cancer Survival, % 90% Relative Percent Surviving 80% 70% 60% 50% 40% 30% 20% In situ Idaho In situ SEER Localized Idaho Localized SEER Regional Idaho Regional SEER Distant Idaho Distant SEER Unstaged Idaho Unstaged SEER 10% 0% Years Survival

27 Colorectal Cancer in Idaho, , Mortality Numbers of Deaths, Age-adjusted and Crude Rates Rates Geography Adjusted Crude Deaths Person-Years Health District ,966 Health District ,038 Health District ,124 Health District ,109,708 Health District ,889 Health District ,239 Health District ,201 State of Idaho ,103,420 US Whites , ,281,936 US All Races , ,788,976 Rates are per 100,000 person-years. Age-adjusted rates use the 2000 U.S. standard.

28 Questions/Comments