我们的目标是确定已知结直肠癌（CRC）风险因素是否对密歇根州的拇指地区的CRC高负担起到贡献作用。拇指地区是密歇根州东部的三县农业乡村地区。我们检查了密歇根癌症监测计划的县级侵袭性CRC发病率和死亡率（2000年至2017年），以及来自公开可得的数据集的CRC风险因素的县级数据。我们使用ANOVA（方差分析）检验将拇指地区的CRC风险因素患病率与密歇根州的其他乡村和城市地区进行比较。使用逐步选择的多变量线性回归模型来评估在考虑其他风险因素后，居住在拇指地区是否与CRC发病率、死亡率和晚期诊断增加有关。 居住在拇指地区（β = 10.4，p = 0.0003）、肥胖（β = 36.9，p = 0.04）和不健康的饮食环境（β = - 2.7，p = 0.003）与较高的CRC发病率相关。吸烟（β = 67.3，p < 0.0001）、无保险（β = - 29.9%，p = 0.03）、居住在拇指地区（β = 2.47，p = 0.03）、较低的结肠镜检验筛查率（β = - 0.14，p = 0.01）和年龄较大（β = 0.11，p = 0.006）与较高的CRC死亡率相关。拇指地区晚期CRC诊断的百分比显著低于州内其他乡村和城市地区（分别为52.9%、58.3%和54.6%，p = 0.03）。 研究结果表明，与密歇根州其他乡村和城市地区相比，居住在密歇根州的拇指地区与较高的CRC发病率和死亡率相关，即使在控制已知风险因素后也是如此。需要进一步研究个体层面的人口统计学、环境、肿瘤和治疗特征（例如，治疗差异、水质、农药使用）来更深入地描述这些发现。© 2023. 作者，独家授权给Springer Nature Switzerland AG.

Our aim was to identify whether known colorectal cancer (CRC) risk factors contribute to the high CRC burden in Michigan's Thumb region, a 3-county agricultural rural area in eastern Michigan.We examined county-level invasive CRC incidence and mortality rates (2000-2017) from the Michigan Cancer Surveillance Program and county-level data on CRC risk factors from publicly available datasets. Prevalence of CRC risk factors in the Thumb region were compared to Michigan's other rural and urban regions using ANOVA (Analysis of Variance) tests. Multivariable linear regression models with stepwise selection were used to assess whether living in the Thumb region was associated with increased CRC incidence, mortality, and late-stage diagnoses after accounting for other risk factors.Living in the Thumb region (β = 10.4, p = 0.0003), obesity (β = 36.9, p = 0.04), and an unhealthy food environment (β = - 2.7, p = 0.003) were associated with higher CRC incidence. Smoking (β = 67.3, p < 0.0001), being uninsured (β = - 29.9%, p = 0.03), living in the Thumb region (β = 2.47, p = 0.03), lower colonoscopy screening (β = - 0.14, p = 0.01), and older age (β = 0.11, p = 0.006) were associated with higher CRC mortality. The percent of late-staged CRC diagnoses was significantly lower in the Thumb region than other rural and urban areas of the state (52.9%, 58.3%, and 54.6%, respectively, p = 0.03).Findings suggest that living in Michigan's Thumb region is associated with higher CRC incidence and mortality compared to Michigan's other rural and urban regions, even after controlling for known risk factors. More studies on individual-level demographic, environmental, tumor, and treatment characteristics (e.g., treatment differences, water quality, pesticide use) are needed to further characterize these findings.© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.