Neighbourhood environments, structural inequities, and colorectal cancer risk and mortality: analysis from the Southern Community Cohort Study

作者：Fekede Asefa Kumsa, Jay H. Fowke, Soheil Hashtarkhani, Brianna M. White, Martha J. Shrubsole, Arash Shaban‐Nejad · 发表于：BMJ Open · 年份：2026 · DOI：10.1136/bmjopen-2026-117881 · 研究领域：Colorectal Cancer Screening and Detection、Nutritional Studies and Diet、Global Cancer Incidence and Screening

OBJECTIVE: Neighbourhood socioeconomic status (nSES) and built environment features strongly influence diet, physical activity and cancer screening adherence, potentially affecting colorectal cancer (CRC) incidence and prognosis. The aim of this study is to assess the association between neighbourhood obesogenic environments (eg, nSES, restaurant and retail food indices, recreational facilities, and business district residence) and CRC risk and mortality. DESIGN: A secondary data analysis was performed using prospectively collected data from the Southern Community Cohort Study. SETTING: 12 states in the Southeastern USA. PARTICIPANTS: We analysed data from 70 519 participants enrolled in the Southern Community Cohort Study. OUTCOMES: The primary outcomes in this study are CRC risk and mortality. DATA ANALYSIS: We used multivariable Cox proportional hazards models, adjusting for individual-level factors to investigate neighbourhood-level risk factors associated with CRC risk and mortality. We further performed race-stratified analyses (Black/White) to examine potential disparities in CRC risk. RESULTS: Among 70 519 participants (69.49% Black, 30.51% White), 927 (1.31%) were diagnosed with CRC (1.37% Black and 1.19% White participants). Of these, 255 (27.5%) died from CRC. Compared with participants residing in the highest (fifth) nSES quintile, those residing in the wealthier (fourth) quintile of nSES exhibited a higher CRC risk (adjusted HR (aHR) 1.27 (95% CI 1.03 to 1.57)). ...