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Tuesday Poster Session

Category: Colon

P4540 - The Rural-Urban Gap in Colorectal Cancer Mortality in the United States: A 22-Year Analysis of National Trends and Disparities

Tuesday, October 28, 2025
10:30 AM - 4:00 PM PDT
Location: Exhibit Hall
Has Audio
ACG Health Equity Research Abstract of Distinction Award
Fatima Zafar, MBBS1, Hamna Manan, MBBS2, Iqra Nawaz, MBBS, BSc3, Muhammad Romail Manan, MBBS, BSc1, Ahmad Zain, MBBS4, Syed Muhammad Ali Najafi, MBBS5, Malik Ahsan Safdar, MBBS1, Muhammad Imtanan Fazal, MD6, Sarah Sheikh, MBBS, MD7
1Services Institute of Medical Sciences, Lahore, Punjab, Pakistan; 2University Hospital Southampton NHS Foundation Trust, Southampton, England, United Kingdom; 3Bahawal Victoria Hospital, Bahawalpur, Bahawalpur, Punjab, Pakistan; 4Parkview Medical Center, Pueblo, CO; 5Services Institute of Medical Sciences, New Haven, CT; 6Jewish Hospital of Cincinnati, Cincinnati, OH; 7Services Institute of Medical Sciences, Faisalabad, Punjab, Pakistan

Introduction:

A rural-urban disparity in colorectal cancer (CRC) mortality has been reported with a significant disease burden in the rural community of the United States. Through this comparative study, we aim to highlight the contrast of CRC mortality between the rural and urban populations to investigate the impact of geographic variations on cancer health disparities.



Methods:

We designed a retrospective study using mortality data from CDC WONDER for adults ≥ 25 years with CRC. Temporal trends in age-adjusted mortality rates (AAMR) and crude mortality rates (CMR) per 100,000 population were noted across rural population (RP) and urban population (UP), stratified by gender, race, age group, state and census region. Joinpoint was used to determine annual percentage change (APC).



Results:

From 1999 to 2020, CRC caused 1,364,117 deaths in the US - 1,096,992 in UP and 267,125 in RP. The total AAMR recorded over twenty-two years was higher in RP (32.1) than in UP (27.8). The AAMR for UP declined significantly, with an APC of -3.1 (1999-2013) and -1.8 (2013-2020). RP showed a significant decline in AAMR until 2014 (APC -2.2), and a non-significant reduction afterwards until 2020 (APC -0.7). The largest UP-related AAMR was observed in small metro areas (28.7), while among RP, it was highest in non-core areas (32.9).Regional analysis revealed the Midwest had the highest AAMR in UP (29.4), and the South in RP (33.2). At state level, West Virginia had the highest UP-related AAMR (35.1), while Alaska had the highest in RP (37.1).


Among UP, men had a higher AAMR (33.7) compared to women (23.4). Similarly, RP-related AAMR was higher in men (38.8) vs. women (26.7). Adults aged 85 and older had the highest CMR in both populations (UP: 256.2; RP: 285.5). African Americans had the highest AAMR in both UP (37.6), and RP (41.9). Analysis of the 22-year trend revealed a significant decrease in AAMR across all racial groups except rural American Indians/Alaska Native, which showed a non-significant decline (APC -0.2).


 



Discussion:

Higher mortality was observed in rural men compared to urban. Rural African Americans also had a higher mortality than their urban counterparts.The disparity in mortality across urbanisation highlights the need for effective screening and accessible treatment services for vulnerable groups.



Figure: A. Line graph representing temporal trends in CRC-associated AAMR for urban and rural populations modelled with Joinpoint regression to identify statistically significant shifts. B. Table showing annual percentage change (APC) for each temporal segment along with 95% confidence intervals and corresponding p-values.

Figure: A. Total deaths and age-adjusted mortality rates (AAMR) associated with colorectal cancer (CRC) in urban and rural populations, stratified by gender. B. Bar graph representing AAMR across different levels of urbanization. C. Comparison of CRC-associated AAMR across U.S. Census regions. D. Choropleth map representing state-wise CRC-related AAMR among rural populations across the U.S. F. Choropleth map representing state-wise CRC-related AAMR among urban populations across the U.S.


Disclosures:
Fatima Zafar indicated no relevant financial relationships.
Hamna Manan indicated no relevant financial relationships.
Iqra Nawaz indicated no relevant financial relationships.
Muhammad Romail Manan indicated no relevant financial relationships.
Ahmad Zain indicated no relevant financial relationships.
Syed Muhammad Ali Najafi indicated no relevant financial relationships.
Malik Ahsan Safdar indicated no relevant financial relationships.
Muhammad Imtanan Fazal indicated no relevant financial relationships.
Sarah Sheikh indicated no relevant financial relationships.


Fatima Zafar, MBBS1, Hamna Manan, MBBS2, Iqra Nawaz, MBBS, BSc3, Muhammad Romail Manan, MBBS, BSc1, Ahmad Zain, MBBS4, Syed Muhammad Ali Najafi, MBBS5, Malik Ahsan Safdar, MBBS1, Muhammad Imtanan Fazal, MD6, Sarah Sheikh, MBBS, MD7. P4540 - The Rural-Urban Gap in Colorectal Cancer Mortality in the United States: A 22-Year Analysis of National Trends and Disparities, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.