Residential mobility and geospatial disparities in colon cancer survival

Abstract

Background: Identifying geospatial cancer survival disparities is critical to focus interventions and prioritize efforts with limited resources. Incorporating residential mobility into spatial models may result in different geographic patterns of survival compared to the standard approach using a single location based on the patient's residence at the time of diagnosis. Methods: Data on 3,949 regional-stage colon cancer cases diagnosed from 2006-2011 and followed until December 31, 2016 were obtained from the New Jersey State Cancer Registry. Geographic disparity based on the spatial variance and effect sizes from a Bayesian spatial model using residence at diagnosis was compared with a time-varying spatial model using residential histories (adjusted for sex, gender, sub-stage, race/ethnicity and census tract (CT) poverty). Geographic estimates of risk of colon cancer death were mapped. Results: Most patients (65%) remained at the same residence, 22% changed CT and 12% moved out of state. The time-varying model produced a wider range of adjusted risk of colon cancer death (0.85-1.20 vs. 0.94-1.11) and resulted in greater geographic disparity statewide after adjustment (25.5% vs. 14.2%) compared to the model with only the residence at diagnosis. Conclusion: Including residential mobility may allow for more precise estimates of spatial risk of death. Results based on the traditional approach using only residence at diagnosis were not substantially different for regional stage colon cancer in New Jersey. Impact: Including residential histories opens up new avenues of inquiry to better understand the complex relationships between people and places, and the effect of residential mobility on cancer outcomes.