BRIEF RESEARCH REPORT article
Front. Epidemiol.
Sec. Epidemiology of Chronic Diseases and Prevention
Volume 5 - 2025 | doi: 10.3389/fepid.2025.1681088
Pre-Pandemic patterns in colorectal cancer mortality and Black-White inequities across the 30 most populous US cities
Provisionally accepted
- 1Stritch School of Medicine, Loyola, University of Chicago, Maywood IL 60153, United States
- 2Sinai Chicago Sinai Urban Health Institute, Chicago, United States
- 3Southwest Healthcare, Temecula, United States
- 4Loyola University Chicago Parkinson School of Health Sciences and Public Health, Chicago, United States
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Background: Colorectal cancer (CRC) is a leading cause of cancer deaths in the US. While national CRC mortality rates have improved over time, this rate differs between non-Hispanic (nH) Black and nH White populations and by geography. Methods: The 30 most populous cities in the US were analyzed using national vital statistics data. Numerators were obtained from death certificates of residents of these cities with CRC as the underlying cause of death. US Census data provided population-based denominators. We calculated Black:White rate ratios (RRs) and corresponding confidence intervals for the most recent time period studied (2017-2019) to assess racial inequities. We calculated average annual percent changes to evaluate CRC mortality trends from 2009-2019. Results: CRC mortality rates statistically significantly decreased nationally and in 25 of the 30 cities. In most cities, nH Black populations experienced a greater decrease in CRC mortality over time than nH White populations. However, in 20 cities, the Black:White CRC mortality rate ratio was greater than 1 (ranging from 1.28 in New York to 2.68 in Washington, D.C.; p<0.05), indicating persistent racial inequities. Between 2009 and 2019, six cities saw statistically significant decreases in racial inequities, two cities saw increases, and the remaining cities demonstrated stable disparities. Conclusions: Despite improvements in CRC mortality, Black:White disparities persist. Structural racism may contribute to these disparities through differential access to care and risk factor exposure Identifying geographic differences in Black:White CRC mortality may catalyze local governments to implement place-based initiatives that reduce screening barriers and contribute to health equity.
Keywords: colorectal cancer, Cancer mortality, Public Health, health equity, Cancer
Received: 06 Aug 2025; Accepted: 25 Sep 2025.
Copyright: © 2025 Bolouri, Saiyed, Benjamins, Munoz, Halterman and Silva. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Maryam Bolouri, mbolouri@luc.edu
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