Disparities in Late-Stage Breast and Colorectal Cancer Diagnosis Among Hispanic, Non-Hispanic White, and Non-Hispanic Black Patients: a Retrospective Cohort Study of Texas Medicare Beneficiaries

Abstract

Background Disparities in late-stage breast or colorectal cancer diagnosis in younger populations are associated with social determinants of health (SDOH; education, poverty, housing, employment). We hypothesized that, in older Medicare beneficiaries, disparities in late-stage cancer diagnosis between Hispanic, non-Hispanic Black (NHB), and non-Hispanic White (NHW) patients would be associated with SDOH, comorbidities, and primary care physician (PCP) access. Methods We analyzed 2005–2017 Texas Cancer Registry data linked with Medicare data for patients aged ≥ 66 ( n = 86,501). Variables included age at diagnosis, sex, comorbidities, poverty level, education, PCP, and relevant cancer screening within 1 year. Results For breast cancer in women (Hispanic, n = 6380; NHW, n = 39,225; NHB, n = 4055), a fully adjusted model showed significantly higher odds of late-stage cancer diagnosis only in NHB patients (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.01–1.22) compared with NHW; adjustment for comorbidities and SDOH partially decreased the odds of late-stage diagnosis relative to NHWs. Interaction terms between race-ethnicity and poverty were not significant. For colorectal cancer , a fully adjusted multivariate model showed significantly higher odds of late-stage diagnosis only among NHBs ( n = 3318, OR 1.29, 95% CI 1.19–1.40) relative to NHWs ( n = 27,470); adjustment for SDOH partially decreased the odds of late-stage diagnosis in NHB patients. Interaction terms between race-ethnicity and poverty were not significant. Conclusion Racial disparities in late-stage breast and colorectal cancer diagnoses remain after adjustment for SDOH and clinically relevant factors, underscoring the need to optimize access to screening and timely cancer treatment in racial/ethnic minorities. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-022-01491-4.

Correlates of U.S. Adults Aged 50–75 Years Having Had a Colorectal Cancer Screening Test

“…3 , 5 Certain segments of the population have the lowest CRC screening rates (e.g., Hispanic compared with White adults, those <200% of the federal poverty line compared with those ≥200% of the federal poverty line, and those with less than a high school education compared with those with greater educational attainment 6 ); these disparities often translate to CRC being found at later stages. 7 , 8 Notably, Black men and women have the highest incidence and mortality rates of CRC than other racial/ethnic groups in the U.S. 9 , 10 …”