Urbanization and Quality of Life condition the incidence of Colorectal Cancer in Córdoba-Argentina

Abstract

Argentina, and specifically Córdoba, have high rates of colorectal cancer (CRC), ranking second in incidence and mortality. Its occurrence correlates with environmental, biological, contextual, and lifestyle exposures. Our objective was to analyze the time series of CRC incidence and identify its association with urbanization and quality of life in Córdoba, Argentina (2004-2014).

A longitudinal ecological study was conducted. Age-standardized incidence rates (ASIR) (standard national and world population) by sex were calculated for Córdoba and its 26 departments for CRC (ICD-10: C18-20), using the provincial tumor registry database. The departments were grouped into three categories, according to the urban scale: High (n=2, cities >400,000 inhabitants); Intermediate (n=13, between 400,000-20,000); and Low (n=11, <20,000). The Quality of Life Index proposed by Velázquez (2010) was employed. Departmental ASIRs were mapped into quintiles. Multilevel modeling was used to estimate the effects (IRR) of sex, time (calendar year), urbanization, and quality of life on ASIRs. Software used: QGis and Stata 17.

At the provincial level, CRC ASIRs were 30.9 (95% CI: 29.9-32.0) and 24.3 (95% CI: 23.3-25.3) cases/100,000 for males and females, respectively, and did not decrease over the past decade. Maps reflected differential geospatial patterns by sex. Spatial variability (at the departmental level) indicated high heterogeneity (Var=0.29; 95% CI: 0.16-0.51). The risk of occurrence was significantly higher in males (IRR: 1.63, 95% CI: 1.53-1.76). Lower incidences of this cancer were significantly associated with better quality of life (IRR: 0.28, 95% CI: 0.16-0.47) and inversely with Intermediate urbanization (IRR: 3.65, 95% CI: 1.59-8.41) and Low urbanization (IRR: 7.4, 95% CI: 2.85-19.51).

Therefore, despite not decreasing over the past decade, the incidence of CRC, associated with urbanization and poor quality of life, remains more pronounced in the male population.