Colorectal Cancer Mortality Projections

Healthy People 2010 Goals

Summary

Healthy People 2010 (HP 2010) is a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats (see https://healthypeople.gov). These objectives were based on two overarching and ambitious goals set in the year 2000: 1) Improve the quality and years of healthy life, and 2) eliminate health disparities. Achieving Healthy People 2010 goals presents the enormous challenge of all population groups achieving rates based on the population group with the “healthiest” rate prior to 2000.

Of the more than 200 HP 2010 objectives, a handful relate specifically to colorectal cancer (CRC). There are also objectives for risk behaviors that are known to influence CRC incidence and progression. These objectives are summarized here.

Healthy People 2010 Volume I and II can be found online. The relevant objectives are listed below, with their HP 2010 numbering. We have added additional commentary about our use of these objectives in the simulation models in some cases.

A midcourse review, assessing progress and updating HP 2010 objectives was conducted.

Cancer Trends Progress Report, summarizes our nation’s progress against cancer in relation to Healthy People targets.

3-5. Reduce the colorectal cancer death rate.

  • Target: 13.7 deaths per 100,000 population (revised from 13.9 during the Healthy People 2010 Midcourse Review).
  • Baseline: 20.9 colorectal cancer deaths per 100,000 population occurred in 1999 (age adjusted to the year 2000 standard population).
  • Target setting method: 34 percent improvement.
  • Data source: National Vital Statistics System (NVSS), CDC, NCHS.
  • Reference: Healthy People 2010 Operational Definition

3-12a. Increase the proportion of adults who have received a Fecal Occult Blood Test (FOBT) in the past 2 years.

  • Target: 33 percent (revised from 50 during the Healthy People 2010 Midcourse Review).
  • Baseline: 34 percent of adults aged 50 years and older reported receiving a fecal occult blood test (FOBT) within the preceding 2 years in 2000 (age adjusted to the year 2000 standard population).
  • Target setting method: Better than the best.
  • Data source: National Health Interview Survey (NHIS), CDC, NCHS.
  • Reference: Healthy People 2010 Operational Definition

3-12b. Increase the proportion of adults who have received a sigmoidoscopy at some point in their lives.

  • Target: 50 percent.
  • Baseline: 37 percent of adults aged 50 years and older reported having ever received a
    sigmoidoscopy in 1998 (age adjusted to the year 2000 standard population).
  • Target setting method: Better than the best.
  • Data source: National Health Interview Survey (NHIS), CDC, NCHS.
  • Reference: Healthy People 2010 Operational Definition

We expanded this objective to include adults who have received either a sigmoidoscopy or colonoscopy. At the time this target was originally set, sigmoidoscopy was the preferred test method. Since then, studies have shown additional benefit from colonoscopy, and it has become more widely used. It is, however, a more costly and invasive procedure and carries a slightly increased risk, so current recommendations are for having either of the tests.

16-16a. Consumption of at least 400 μg of folic acid each day from fortified foods or dietary supplements by nonpregnant women aged 15 to 44 years

  • Target: 80 percent.
  • Baseline: 21 percent of women of childbearing age consumed 400 μg or more daily in 1991-1994.
  • Target setting method: Better than the best.
  • Data source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.
  • Reference: Healthy People 2010 Operational Definition

This Healthy People 2010 objective is clearly not aimed at colorectal cancer prevention, but we used it as a surrogate for multivitamin use, which has been shown to have a beneficial effect for CRC.

19-1.  Increase the proportion of adults who are at a healthy weight.

  • Target: 60 percent.
  • Baseline: 42 percent of adults aged 20 years and older were at a healthy weight (defined as a body mass index [BMI] equal to or greater than 18.5 and less than 25) in 1988–94 (age adjusted to the year 2000 standard population).
  • Target setting method: Better than the best.
  • Data source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.
  • Reference: Healthy People 2010 Operational Definition

19-2.  Reduce the proportion of adults who are obese.

  • Target: 15 percent.
  • Baseline: 23 percent of adults aged 20 years and older were identified as obese (defined as a BMI of 30 or more) in 1988–94 (age adjusted to the year 2000 standard population).
  • Target setting method: Better than the best.
  • Data source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.
  • Reference: Healthy People 2010 Operational Definition

19-5.  Increase the proportion of persons aged 2 years and older who consume at least two daily servings of fruit.

  • Target: 75 percent.
  • Baseline: 28 percent of persons aged 2 years and older consumed at least two daily servings of fruit in 1994–96 (age adjusted to the year 2000 standard population).
  • Target setting method: Better than the best.
  • Data source: Continuing Survey of Food Intakes by Individuals (CSFII) (2-day average), USDA.
  • Reference: Healthy People 2010 Operational Definition

Rather than modeling fruit and vegetable consumption separately, we combined this objective (for eating fruit) with the following objective (for eating vegetables) and came up with “consumption of at least 5 servings of fruits or vegetables daily.” We assumed that the HP 2010 target for this hybrid target would be the lesser of the two targets, or 50%.

19-6.  Increase the proportion of persons aged 2 years and older who consume at least three daily servings of vegetables, with at least one-third being dark green or orange vegetables.

  • Target: 50 percent.
  • Baseline: 3 percent of persons aged 2 years and older consumed at least three daily servings of vegetables, with at least one-third of these servings being dark green or orange vegetables in 1994–96 (age adjusted to the year 2000 standard population).
  • Target setting method: Better than the best.
  • Data source: Continuing Survey of Food Intakes by Individuals (CSFII) (2-day average), USDA.
  • Reference: Healthy People 2010 Operational Definition

See commentary above. This objective was combined with the previous one to become “consumption of at least 5 servings of fruits or vegetables daily.” 

22-1.  Reduce the proportion of adults who engage in no leisure-time physical activity.

  • Target: 20 percent.
  • Baseline: 40 percent of adults aged 18 years and older engaged in no leisure-time physical activity in 1997 (age adjusted to the year 2000 standard population).
  • Target setting method: Better than the best.
  • Data source: National Health Interview Survey (NHIS), CDC, NCHS.
  • Reference: Healthy People 2010 Operational Definition

22-2.  Increase the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30 minutes per day.

  • Healthy People 2010 Objective
    • Target: 30 percent.
    • Baseline: 15 percent of adults aged 18 years and older engaged in moderate physical activity for at least 30 minutes 5 or more days per week in 1997 (age adjusted to the year 2000 standard population).
  • Midcourse Review Modification
    • Target: 50 percent
    • Baseline: 32 percent of adults aged 18 years and older engaged in moderate physical activity for at least 30 minutes per day or vigorous physical activity for at least 20 minutes per day in 1997 (age adjusted to the year 2000 standard population).
  • Target setting method: Better than the best.
  • Data source: National Health Interview Survey (NHIS), CDC, NCHS.
  • Reference: Healthy People 2010 Operational Definition

22-3.  Increase the proportion of adults who engage in vigorous physical activity that promotes the development and maintenance of cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion.

  • Target: 30 percent.
  • Baseline: 23 percent of adults aged 18 years and older engaged in vigorous physical activity 3 or more days per week for 20 or more minutes per occasion in 1997 (age adjusted to the year 2000 standard population).
  • Target setting method: Better than the best.
  • Data source: National Health Interview Survey (NHIS), CDC, NCHS.
  • Reference: Healthy People 2010 Operational Definition

27-1a. Reduce the proportion of adults who smoke cigarettes.

  • Target: 12 percent.
  • Baseline: 24 percent of adults aged 18 years and older smoked cigarettes in 1998 (age adjusted to the year 2000 standard population).
  • Target setting method: Better than the best.
  • Data source: National Health Interview Survey (NHIS), CDC, NCHS.
  • Reference: Healthy People 2010 Operational Definition

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