Risk factors impacting colon and/or colorectal cancer mortality among American Indians/Native Americans and Non-Hispanic Whites

Risk factors for colon (or colorectal) cancer mortality for American Indians/Alaska Natives (AI/AN) has been understudied. This project's overall aim is to determine colon and colorectal cancer risk factors among AI/AN. Colorectal cancer risk factors from the literature were determined utilizing systematic review methods. Comorbidities, travel times to screening and treatment, were also explored as risk factors for colon cancer mortality using cox proportional hazards modeling to determine hazard ratios. The systematic review revealed that race was the only risk factor explored for colon or colorectal cancer among AI/AN, whereas numerous colon or colorectal cancer risk factors have been explored for Non-Hispanic Whites (NHW). Next was examining risk for colon cancer mortality by building models. An increasing Charlson comorbidity index had higher risk for mortality among NHW. Models examining travel times that were race specific resulted in greater risk for AI/AN and mortality for those having to travel longer to a chemotherapy facility. Longer travel time to a screening facility increased NHW risk for mortality. NWH increased travel time to a surgical center had a decreased risk for mortality. The regional and distant stage model showed that AI/AN living a distance from chemotherapy had increased risk for mortality. For NHW, living a distance from a screening facility had increased mortality. The all stage model for NHW showed that living further to a screening facility increased mortality risk but living further from a surgical center decreased one's risk for mortality.