Race and Colon Cancer Survival in an Equal-Access Health Care System

Abstract

Studies have shown that whites have a higher colorectal cancer survival rate than blacks. However, it is unclear whether racial disparities result from unequal access to medical care or factors other than healthcare access or both. This study assessed whether non-Hispanic Whites (NHWs) and non-Hispanic Blacks (NHBs) differ in colon cancer (CC) survival in an equal-access healthcare system and examined whether racial differences varied by demographic and tumor characteristics. The study included 2,537 Military Health System patients diagnosed with CC between 1998 and 2007. Median follow-up time was 31.4 months. Cox models estimated hazard ratios (HR) and 95% confidence intervals (CI) for race, overall and stratified by age at diagnosis, sex, and tumor stage. No difference in overall survival (OS) between NHWs and NHBs was observed in general. However, among patients younger than 50 years old, NHBs experienced significantly worse OS than NHWs (HR: 2.27, 95% CI: 1.48–3.49). Further stratification by sex and tumor stage showed that this racial disparity was confined to women (HR: 2.80, 95% CI: 1.30–6.00) and patients with distant stage disease (HR: 2.65, 95% CI: 1.38–5.08) in this age group. When medical care is equally available to NHWs and NHBs, similar overall CC survival was observed; however, evidence of racial differences in survival was apparent for patients younger than 50 years old. This study suggests that factors other than access to care may be related to racial disparities in CC survival among younger, but not older, patients.

Insurance Payer Status and Race Explains Much of the Variability in Colorectal Cancer Survival

“…Investigators have found that in the Veterans' Administration or military insured families, socioeconomic and racial factors have no or little influence on outcomes for patients with colorectal cancer [12] [14]. Comparisons between impoverished Canadian colon cancer patients and those in the US demonstrate improved quality, increased use of chemotherapy and better survival for Canadians [28] [29].…”

“…Accounting for these potential confounding factors unveils a more complex picture [4] [7] [8] [11] [12] [14] [15]. For example, in an equal access system, the Veteran's Administration, outcomes disparities across racial lines are significantly diminished [12] [14]. It is likely that poorer outcomes for AA are, in part, secondary to unequal use of screening, surgical resection, adjuvant therapy and appropriate follow-up [13] [16]- [20].…”

The Impact of Preexisting Mental Health Disorders on the Diagnosis, Treatment, and Survival among Lung Cancer Patients in the U.S. Military Health System

“…The linked database from the Department of Defense (DoD)’s Central Cancer Registry (CCR) and the MHS Data Repository (MDR) was used in this study and described previously (39, 40). The CCR contains information on cancer patients diagnosed or treated at military treatment facilities (MTFs).…”

Age-related rates of colorectal cancer and the factors associated with overall survival

“…Several studies have characterized differences in the treatment of CRC, including access to surgery and chemotherapy based on age, race, geographic location and other socioeconomic factors like insurance status and income (10)(11)(12)(13)(14)(15). Importantly, differences in access to these treatments have been associated with worse survival outcomes for patients with early-onset CRC of minority racial populations (16,17). The purposes of this study were to identify differences in both demographic and pathologic factors associated with the age-related rates of CRC and to assess the interaction these variables on overall survival (OS) in early onset CRC.…”