Racial differences in tumor stage and survival for colorectal cancer in an insured population

Abstract

BACKGROUND: Despite declining death rates from colorectal cancer (CRC), racial disparities have continued to increase. In this study, the authors examined disparities in a racially diverse group of insured patients. METHODS: This study was conducted among patients who were diagnosed with CRC from 1993 to 1998, when they were enrolled in integrated healthcare systems. Patients were identified from tumor registries and were linked to information in administrative databases. The sample was restricted to non-Hispanic whites (n = 10,585), non-Hispanic blacks (n = 1479), Hispanics (n = 985), and Asians/Pacific Islanders (n = 909). Differences in tumor stage and survival were analyzed by using polytomous and Cox regression models, respectively. RESULTS: In multivariable regression analyses, blacks were more likely than whites to have distant or unstaged tumors. In Cox models that were adjusted for nonmutable factors, blacks had a higher risk of death from CRC (hazard ratio [HR], 1.17; 95% confidence interval [95% CI], 1.06-1.30). Hispanics had a risk of death similar to whites (HR, 1.04; 95% CI, 0.92-1.18), whereas Asians/Pacific Islanders had a lower risk of death from CRC (HR, 0.89; 95% CI, 0.78-1.02). Adjustment for tumor stage decreased the HR to 1.11 for blacks, and the addition of receipt of surgical therapy to the model decreased the HR further to 1.06. The HR among Hispanics and Asians/Pacific Islanders was stable to adjustment for tumor stage and surgical therapy. CONCLUSIONS: The relation between race and survival from CRC was complex and appeared to be related to differences in tumor stage and therapy received, even in insured populations. Targeted interventions to improve the use of effective screening and treatment among vulnerable populations may be needed to eliminate disparities in CRC

Effects of Socioeconomic Status and Treatment Disparities in Colorectal Cancer Survival

“…Barriers to access have been shown to contribute to poorer screening rates (55)(56)(57). Confounding the screening process is the observation that African-Americans present more frequently with proximal tumors (47,58,59) and at a younger age (51), which we also observed. This underscores the importance of colorectal screening in this population and has been the impetus for proposing modified screening guidelines (60).…”

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

“…S u rgi ca l tr ea tmen t o f co l o r ec ta l c a n cer in African-Americans and Whites: Among patients who underwent surgery for rectal cancer, the rate of sphincter-ablating procedure was 37% for Whites and 43% for Blacks [adjusted odds ratio (AOR) 1.42, 95% CI 1.23-1.65] [83] . Blacks had a higher risk of dying from colorectal cancer (HR 1.17, 95% CI 1.06-1.30) in a study and adjustment for tumour stage reduced the hazard ratio to 1.11 and surgical treatment further reduced hazard ratio to 1.06 [84] . Black patients were more likely than Whites not to receive surgical treatment in stage Ⅰ (OR = 2.08, 95% CI 1.41-3.03 among males; OR = 2.38, 95% CI 1.69-3.45 among females) and Ⅳ (OR = 1.25, 95% CI 1.01-1.56 among males; OR = 1.41, 95% CI 1.14-1.72 among females) colon cancer and most stages of rectal cancer, and they were more likely to refuse recommended treatment [85] .…”

Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System

“…CRC diagnosis information was obtained from tumor registry data. 31 CRC tests were identified using Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes from electronic data. The results of guaiac fecal occult blood tests (gFOBT)/FIT were obtained from laboratory databases.…”