Which social determinants of health have the greatest impact on rural–urban colorectal cancer mortality disparities?

Study shows that rural and urban counties have some overlapping and some different drivers of colorectal cancer deaths, indicating the need for targeted area-level interventions.

2025-11-24

(Press-News.org) New research reveals that certain social determinants of health—such as socioeconomic status, household characteristics, and racial/ethnic minority status—have significant effects on rural–urban disparities in colorectal cancer mortality rates. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

Using 1999–2020 colorectal cancer mortality data from the Centers for Disease Control and Prevention pertaining to all US counties, investigators assessed how different components of the Social Vulnerability Index might affect differences in colorectal cancer deaths in rural versus urban areas. The Social Vulnerability Index includes 14 social determinants of health grouped into 4 related themes: socioeconomic status, household composition and disability, minority status and language, and housing and transportation.

Among 2,927 counties, rural counties had 11.8% higher colorectal cancer mortality than urban counties. Analyses revealed that 18.6% of that disparity was mediated by low socioeconomic status (higher poverty and unemployment and lower income and education), 8.8% by household characteristics, and 2.7% by racial/ethnic minority status.

Among all counties, poverty, unemployment, lacking a high school diploma, household crowding, and lacking a vehicle had the strongest impact on colorectal cancer mortality. While lacking access to a vehicle increased colorectal cancer mortality risk among all counties, rural counties were affected to a greater extent than urban counties.

“Our findings show that while socioeconomic vulnerability drives much of the disparity in colorectal cancer mortality, the rural–urban gap is shaped by a broader set of contextual factors,” said senior author Kelly M. Kenzik, MS, PhD, of the Patient-Reported Outcomes, Value, and Experience (PROVE) Center, Department of Surgery, Brigham and Women’s Hospital. “Composite indices like the Social Vulnerability Index offer important insight into population-level risk, but actionable progress will depend on domain-specific measures that identify concrete barriers and facilitators, guiding resource allocation and policy tailored to local needs.”

Additional information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the CANCER Newsroom upon online publication. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com

Full Citation:
“Beyond composite measures of regional vulnerability: Rural-urban colorectal cancer mortality disparities mediated by area-level characteristics.” Sara Myers, Elizabeth S. Davis, Jeffrey A. Franks, Jennifer S. Davids, and Kelly M. Kenzik. CANCER; Published Online: November 24, 2025 (DOI: 10.1002/cncr.70098).
URL Upon Publication: http://doi.wiley.com/10.1002/cncr.70098

Author Contact: Terry MacCormack, of the Mass General Brigham Communications Office, at tmaccormack@mgb.org.

About the Journal   
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online. Follow CANCER on X @JournalCancer and Instagram @ACSJournalCancer, and stay up to date with the American Cancer Society Journals on LinkedIn.

About Wiley    
Wiley is a global leader in authoritative content and research intelligence for the advancement of scientific discovery, innovation, and learning. With more than 200 years at the center of the scholarly ecosystem, Wiley combines trusted publishing heritage with AI-powered platforms to transform how knowledge is discovered, accessed, and applied. From individual researchers and students to Fortune 500 R&D teams, Wiley enables the transformation of scientific breakthroughs into real-world impact. From knowledge to impact—Wiley is redefining what's possible in science and learning. Visit us at Wiley.com and Investors.Wiley.com. Follow us on Facebook, X, LinkedIn and Instagram.

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