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Abstract

Background: Colorectal cancer (CRC) is a growing public health concern, especially among older adults. In Thailand, CRC risk is influenced by individual and environmental factors. This study investigates the association between individual- and contextual-level factors and CRC risk in Thai older adults.

Methods: A retrospective cohort study included 11,167 adults aged ≥60 years from the Khon Kaen Cohort Study (1990–2001), followed through 2020. CRC cases were histologically confirmed. Multilevel Cox regression estimated hazard ratios (HRs) with 95% confidence intervals (CIs).

Results: Over a median follow-up of 21.7 years, 100 CRC cases were identified. At the individual level, unemployment (HR = 2.45, 95% CI: 1.37–4.39) and a family history of cancer (HR = 1.65, 95% CI: 1.13–2.41) increased CRC risk. Height in the 1st and 3rd quartiles also elevated risk compared to the 2nd quartile (HR = 2.04, 95% CI: 1.20–3.45; HR = 1.98, 95% CI: 1.14–3.46). Contextually, living in regions with high rural household proportions (HR = 2.07, 95% CI: 1.11–3.87) and moderate poverty rates (HR = 2.16, 95% CI: 1.20–3.91) was linked to greater CRC risk.

Conclusions: Individual and contextual factors significantly impact CRC risk in older Thai adults. Addressing socio-environmental disparities and improving early detection strategies are key to reducing the CRC burden.

Keywords: Colorectal cancer, Multilevel analysis, Risk factors, Thai older adults

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