Inverse Association Between Regional Availability of Board‐Certified Fellows of the Japan Gastroenterological Endoscopy Society and Colorectal Cancer Mortality in Japan: An Ecological Analysis

ABSTRACT Aims We investigated the association between prefecture‐level colorectal cancer (CRC) mortality and contributing factors, including the regional availability of Board‐Certified Fellows of the Japan Gastroenterological Endoscopy Society (BCFJGES), using publicly available data from all 47 Japanese prefectures. Methods and Results This prefecture‐level ecological cross‐sectional study used publicly available national data from e‐Stat, Cancer Statistics by the Japan National Cancer Center, and JGES records. The dependent variable was the CRC‐specific age‐standardized mortality rate (AMR) among individuals aged b ] = 0.213, p  = 0.011), alcohol consumption ( b  = 0.045, p  = 0.003), physical activity ( b  = −0.087, p  = 0.024), and BCFJGES density ( b  = −1.339, p  p   Conclusion Higher prefecture‐level smoking and alcohol consumption were associated with higher CRC mortality, while higher physical activity and higher BCFJGES density were associated with lower mortality. Regional disparities in BCFJGES distribution across Japan may contribute to CRC mortality and warrant continued surveillance and policy attention.