Effects of Socioeconomic Status and Treatment Disparities in Colorectal Cancer Survival

Le, Hoa Van; Ziogas, Argyrios; Lipkin, Steven M.; Zell, Jason A.

doi:10.1158/1055-9965.epi-07-2774

Cited by 185 publications

(162 citation statements)

References 60 publications

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“…Timely treatment is an important factor for survival following a CRC diagnosis. Several studies have shown that people with lower socioeconomic status (SES) delay treatment for CRC due to a host of factors, including lack of knowledge, referral bias, inadequate health insurance, and limited access to health care facilities (26)(27)(28). Although data on regional variations in CRC treatment are limited, CRC patients residing in rural areas or poorer neighborhoods are less likely to receive adjuvant chemotherapy than patients residing in urban or more affluent areas (29,30).…”

Section: Discussionmentioning

confidence: 99%

“…Nationally, reduction in CRC death rates has been much slower in blacks than in whites (39), partly because blacks are more likely to have lower SES, which is associated with poorer access to treatment and preventive services (26), to have higher risk perception to interventions (29,40,41), are less likely to be screened or referred for CRC screening by their physicians (42,43). However, the direction of the trend in CRC death rates within each state was generally similar in non-Hispanic blacks and non-Hispanic whites, though the magnitude of the trend varied for some states (Supplementary Table S1A and B).…”

Section: Discussionmentioning

confidence: 99%

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State Disparities in Colorectal Cancer Mortality Patterns in the United States

Naishadham

Lansdorp–Vogelaar

Siegel

et al. 2011

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Colorectal cancer (CRC) mortality rates have been decreasing for many decades in the United States, with the decrease accelerating in the most recent time period. The extent to which this decrease varies across states and its influence on the geographic patterns of rates is unknown.Methods: We analyzed the temporal trend in age-standardized CRC death rates for each state from 1990 to 2007 using joinpoint regression. We also examined the change in death rates between 1990-1994 and 2003-2007 using rate ratios with 95% confidence intervals and illustrated the change in pattern using maps. The relationship between the change in mortality rates and CRC screening rates for 2004 by state was examined using Pearson's correlation.Results: CRC mortality rates significantly decreased in all states except Mississippi between 1990 and 2007 based on the joinpoint model. The decrease in death rates between 1990-1994 and 2003-2007 ranged from 9% in Alabama to greater than 33% in Massachusetts, Rhode Island, New York, and Alaska; Mississippi and Wyoming showed no significant decrease. Generally, the northeastern states showed the largest decreases, whereas southern states showed the smallest decreases. The highest CRC mortality rates shifted from the northeastern states during 1990 to 1994 to the southern states along the Appalachian corridor during 2003 to 2007. The decrease in CRC mortality rates by state correlated strongly with uptake of screening (r ¼ À0.65, P < 0.0001).Conclusions: Progress in reducing CRC mortality varies across states, with the Northeast showing the most progress and the South showing the least progress.Impact: These findings highlight the need for wider dissemination of CRC screening. Cancer Epidemiol Biomarkers Prev; 20(7); 1296-302. Ó2011 AACR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

State Disparities in Colorectal Cancer Mortality Patterns in the United States

Naishadham

Lansdorp–Vogelaar

Siegel

et al. 2011

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…First, recent US studies of colon cancer treatment and survival have consistently found that socioeconomic differences explained most racial-group differences. [60][61][62][63] Second, although we were not able to adjust for this factor directly because the Ontario registry does not code race/ethnicity, we were able to replicate key findings by comparing the subsample of nonHispanic White patients in San Francisco with the entire racially and ethnically diverse Toronto sample. In what was perhaps the most provocative between-place comparison-5-year survival of low-income patients with stage II or III colon cancer-our original analysis revealed a Toronto advantage, and this advantage remained even when we excluded all members of any racial/ethnic minority group that composed more than half of the original low-income San Francisco sample.…”

Section: Limitationsmentioning

confidence: 95%

Effects of Socioeconomic Status on Colon Cancer Treatment Accessibility and Survival in Toronto, Ontario, and San Francisco, California, 1996–2006

Gorey¹,

Luginaah²,

Bartfay³

et al. 2011

Am J Public Health

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Objectives-We examined the differential effects of socioeconomic status on colon cancer care and survival in Toronto, Ontario, Canada, and San Francisco, California.Methods-We analyzed registry data for colon cancer patients from Ontario (n=930) and California (n=1014), diagnosed between 1996 and 2000 and followed until 2006, on stage, surgery, adjuvant chemotherapy, and survival. We obtained socioeconomic data for individuals' residences from population censuses.Correspondence should be sent to Kevin Gorey, School of Social Work, University of Windsor, 401 Sunset Ave, Windsor, Ontario, N9B 3P4 gorey@uwindsor.ca. Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link. ContributorsK. M. Gorey conceptualized and supervised the study and led the writing. K. Y. Fung led the analysis. All authors assisted with study design, data analysis, and interpretation and writing. Human Participant Protection CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptResults-Income was directly associated with lymph node evaluation, chemotherapy, and survival in San Francisco but not in Toronto. High-income persons had better survival rates in San Francisco than in Toronto. After adjustment for stage, survival was better for low-income residents of Toronto than for those of San Francisco. Middle-to low-income patients were more likely to receive indicated chemotherapy in Toronto than in San Francisco.Conclusions-Socioeconomic factors appear to mediate colon cancer care in urban areas of the United States but not in Canada. Improvements are needed in screening, diagnostic investigations, and treatment access among low-income Americans.A study of cancer survival in low-income areas of Toronto, Ontario, and Detroit, Michigan, during the 1980s found advantages among Canadians for common cancers. 1 The Toronto survival advantage was replicated for breast cancer across diverse low-income Canadian and US contexts through the 1990s. 2 Studies of that era, however, were not able to account for differences in stage of disease at diagnosis. More recent studies that accounted for breast cancer stage again found Canadian advantages. [3][4][5][6] In the United States, women with breast cancer who lived in low-income areas waited longer for surgery and adjuvant radiation therapy and were less likely to receive radiation therapy or to survive. Similar disparities between high-and low-income women with breast cancer did not exist in Canada; thus lowincome Canadians fared better across most breast cancer care indices than their US counterparts. More inclusive health insurance in Canada was advanced as the most plausible explanation.Colon cancer care may be an even more important health care performance indicator. The second most frequent cause of cancer death in North America, its prognosis can be excellent with early diagnosis and treatment. 7,8 For several reasons, colon cancer seems particularly instructive for Canada-US cancer care comparisons. First, research on income and colon cancer survi...

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“…After adjustment for age, sex, histology, site within the colon, and stage, African Americans are more likely to die compared with Caucasian patients with colorectal cancer (colon: HR 1.19, 95% CI 1.14-1.25; rectum: HR 1.27, 95% CI 1.17-1.38). However, after further adjustment for socioeconomic status and treatment, the risk of death for African-Americans compared with Caucasians is substantially diminished (colon: HR 1.08, 95% CI 1.03-1.13; rectum: HR 1.11, 95% CI 1.02-1.20) [77] . Survival in patients suffering from colorectal cancer with more than 16 years of education increased from 1993 to 2001 [2.4% (P < 0.001), 4.8% (P = 0.011), 3.0% (P < 0.001), and 2.6% (P = 0.030) annually among white men, black men, white women, and black women, respectively].…”

Section: Racial Prognosis Difference Due To Socioeconomic Status Stamentioning

confidence: 99%

Disparities in colorectal cancer in African-Americans vs Whites: Before and after diagnosis

Dimou¹,

Syrigos²,

Saif³

2009

WJG

123

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Effects of Socioeconomic Status and Treatment Disparities in Colorectal Cancer Survival

Cited by 185 publications

References 60 publications

State Disparities in Colorectal Cancer Mortality Patterns in the United States

State Disparities in Colorectal Cancer Mortality Patterns in the United States

Effects of Socioeconomic Status on Colon Cancer Treatment Accessibility and Survival in Toronto, Ontario, and San Francisco, California, 1996–2006

Disparities in colorectal cancer in African-Americans vs Whites: Before and after diagnosis

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