Examining the Direct and Indirect Effects of Socioeconomic Status on Colorectal Cancer Using Structural Equation Modeling

The direct and indirect effects of socioeconomic status (SES) on colorectal cancer (CRC) were examined using structural equation modeling in a case-control study with 488 CRCs and 651 controls. SES was measured by education, income and resident region. SES (odds ratio (OR)=0.89), age (OR = 1.03), processed meat intake (OR = 1.08), lack of CRC screening (OR = 2.67), smoking (OR = 1.85) and family history (OR = 1.06) were significantly associated with CRC risk. SES had a direct effect on CRC risk (β = -0.05). An indirect effect of SES on CRC also existed which was mediated by processed meat intake (β = -0.02), vegetable intake (β = -0.01), CRC screening uptake (β = -0.02), and smoking (β = -0.02).