♪ And a look at medical news today.

Researchers at the University of Kentucky have found that for much of the past 2 decades Appalachian, Kentucky hands have been more likely to die from colorectal cancer compared to the rest of the state and country's population.

Their study was recently published in the Journal of Gastroenterology.

Yesterday I sat down with the UK researchers to learn more about where you live can contribute to higher chances of dying from colorectal cancer.

>> I think one of the the points that were making the study is that there's a real signal with regards to people that are from rural Kentucky, especially Appalachian counties and in particular, they haven't quite benefited as much from the, you know, the the Medicaid expansion and increased screen rage has been a benefit but nowhere near the kind of benefit that the rest of the country has a enjoyed from reduced colon cancer.

Right?

>> Let's talk about some of these barriers.

What are they that sing to distinguish them more rule Appalachian dwellers from their urban counterparts?

Will these barriers on different levels?

We have to consider patient barriers, organizational barriers as well.

On the patient level, these barriers could be.

>> Perceived to fear of screening or, you know, perceived pain as it was all off, offer screening of probably due low health literacy o purple to colorectal cancer.

The other could be, of course, little appear.

People saying in the low socioeconomic status, meaning they're probably thinking that they're not all able to afford called cancer screening.

And the same time the researchers also show that educational attainment is a big factor.

He's also a towards Colorado cancer screening, which study showing that people who have achieved less than high school education level education are basically have need in the straits of colorectal cancer screening and that probably access to health care is another one of them given the location off eastern Kentucky.

That is There are issues related transport and other access to major health care networks where they seek care.

>> How much does the fact that they may or may not have a medical home or by Mary Care physician with whom they interface with frequently to make those referrals and to make sure they're doing screening such as colorectal screenings.

Is that important?

>> It's very important because when you don't have access major health care network such as user can talk and the other major networks it's very important to, you know, be in touch and have regular apartments with your primary care provider so that they can guide you regarding screening processes.

As you know, probably not everyone is willing to undergo colonoscopy because some of them probably have had a bad experience.

But there are other modalities available to screen patients for council such as to still probably believe the room.

>> Let's start at home.

Exactly A lot.

And right to abuse rules.

Physicians have a huge role to play in terms of educating the community.

And, you know, pushing through with all of that.

And he's the former screening needs to be done well in these patients.

>> And is it a matter that to Barrett of there not being enough gastroenterologists and those rule Appalachian areas that also of pain point, I think that has improved.

I think the in terms of screening costly to have gotten better.

I don't think it's it's a deal.

And I think in what you find in the world communities is there's a barrier with you guys.

Just transportation.

We talked about this so that before the associated that feeling in the city, you can get an alley.

You can get public transportation.

It's a little bit harder to get out how are, you know, get out of there.

Go to the Dodgers place.

Have somebody to drive you home to transportation, I think is one of the unique barriers that you see in the rural populations, especially Appalachian that you may not see in an indigent population, the city.

Right.

And I expect some point you raise.

I really think you're a family practice is how they get keepers.

And and one of things that I've noticed here at the university is said the state really gets on top of our family practice guys for screening rates.

Like if if they're screening rates aren't up to par, they threatened that they're not getting the funding there.

They're going to withhold funds.

So we have all sorts of mechanisms for increasing their screening rates.

So if you can get the patient into the family practice, doctors office you they're probably going to find a way to get him screen rights right?

>> So let's talk about going to sometimes it seems like they the information about the standard of care about when to get screened at what age and how often it can often be confusing.

It seems to vacillate between this aid in that age.

Can you set the record straight on when the appropriate age or conditions for screening?

So on to down to 45 now.

So we're we're starting to screen at 45 in as part of a national trend that Tom cancers occur in younger age.

She writes, and certainly this 45 too late for some population.

Yeah.

So if you're a family, it's like a primary family members getting colon cancer under 65.

And you should be probably looking at an earlier screening debut.

And that's a significant risk.

If you have somebody in your family, you know, siblings or parents or whatever the guys I would say to the screen is I think if you a family member might I'm going to advise the court asked me because you'd be able to see all the different pop, small, medium, large But >> if for whatever reason they don't, they don't want to do.

The court asked the maybe no, they just didn't like the idea of a term or or maybe it's transportation to, you know, maybe there's some other barriers there.

If we get them at least a stool test, we've got some kind of screening modality this to a test to identify large polyps or cancers.

So it's going to be a little beyond at least identify the people really need something done and urgently.

>> There are other that the Apple watches are more prone to when it comes to, I guess, turned to algae.

>> Yeah, thanks to that that we had we started out looking at this kind of question with Crohn's and will serve Clyde, a seizure diseases that we specialize in it.

The UK and it's quite dramatic how much more severe the Crohn's and also claims he sure I think was from Northwestern in Chicago and we should pass search of severe disease stateside didn't see people that died were is when I came here and you know, was in first years us off here for people have died from And I remember talking to my mentors at University of Chicago and I said, yeah, I've never seen anybody die except for cancer.

You know, when the cancer cones.

So there we started looking at that in the Appalachian counties, very similar story where you much more severe and more likely to go to surgery.

More likely require steroids gets back to the question of why, right?

You know, guest to talk about all these detection and in access to care.

I actually think that what is pointing to is there's a cause.

There's there's something in either the diet or its pollution from, you know, from any number of full mental factors where there's there's something putting our patients at risk in there.

They're not only sound like cancer, but it's all these autoimmune diseases, probably heart disease and other things.

And it's not smoke.

It sent smoking if there is a factor, sure that smoking isn't good for licenses but that some of you I've got plenty of horribly sick, Crohn's patients that don't smoke and they're from these Appalachian counties, even some of them from our that we get it from the Appalachian counties in Ohio.

You know, so to there's something that had at the start of this, there's something about the that the diet of the environment that that it's going require more research.

>> Was going to say, where is that research?

And is it being done?

So we have a young faculty in our place.

Kids like Courtney Perry who starting to look at this and she's going to be going into the cities and interviewing patients to figure out what are the common features of these things.

>> And I think that that we have to study all sorts of things diets, probably one behavior, cultural trends, all sorts of stuff to try to figure out what are the common themes because it's not just one county, it's always Appalachian counties.

And is this a hallmark?

So it's good.

It's and I think the NH the federal government's very interested in this because for a long time, it spent a lot of money and your populations in cities and urban poor.

It's this kind of a new a bright light to India.

This is we need to shine a light on this area because there's this real world.

Indigent populations really require more study so that we can turn their health care around.

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