Racial disparities negatively impact outcomes in early‐onset colorectal cancer independent of socioeconomic status

Kamath, Suneel; Torrejon, Nataly Valeria; Wei, Wei; Tullio, Katherine; Nair, Kanika G.; Líška, Dávid; Krishnamurthi, Smitha; Khorana, Alok A.

doi:10.1002/cam4.4276

Cited by 33 publications

(27 citation statements)

References 38 publications

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“…This is similar to the association noticed for other YO‐GI cancers such as YO‐colorectal cancer. 7 The risk factors that have been established for pancreatic cancer include obesity, alcohol use, family history of pancreatic cancer, diabetes mellitus, smoking, and pancreatitis with the strongest dose‐dependent association with alcohol use among patients <45 years versus those <60 years. 10 Therefore, one could hypothesize the increasing incidence of obesity and variability in exposure to known risk factors at least partly explain the pattern observed in YO‐PBA.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, other YO‐GI cancers such as YO‐CRC are also known to be associated with an advanced stage at presentation compared to AO disease. 1 , 7 , 18 It is unclear if this is related to the biology of the disease versus a delay in the timely diagnosis of PBA in a young patient compared to an older patient given the influence of a lower risk profile on medical judgment. 6 Unlike CRC, where lack of screening could partly explain the higher stage of disease at presentation for YO‐PBA patients, such a case doesn’t exist for PBA.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of characteristics and outcomes of young‐onset versus average onset pancreatico‐biliary adenocarcinoma

et al. 2023

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Background Young‐onset gastrointestinal malignancies appear to be increasing in incidence. There are limited data on young‐onset pancreaticobiliary adenocarcinoma (YO‐PBA). Methods The study comprised patients with PBA (pancreatic adenocarcinoma, intra‐, and extra‐hepatic cholangiocarcinoma) and included in the National Cancer Database (NCDB) between 2004 and 2017. YO‐PBA was defined as a diagnosis at age less than 50 years. Logistic regression to assess factors associated with YO‐PBA status, and cox proportional hazards modeling to associate relevant factors with overall survival was performed. Results The study cohort comprised 360,764 patients, with 20,822 (5.8%) YO‐PBA. YO‐PBA was associated with ( p ‐values<0.0001 for all): male sex (6.3% YO‐male out of all male patients vs. 5.2% YO‐female, OR 1.29, 95% CI 1.25–1.33), Black race (7.9% YO‐Black vs. 5.0% YO‐White, OR 1.72, 95% CI 1.64–1.80), lower income (6.4% YO‐lowest household income based group vs. 5.5% highest, OR 1.08, 95% CI 1.03–1.13). YO‐PBA were more likely to present with stage‐IV disease (6.4% YO‐Stage IV of all stage IV vs. 5.4% YO‐Stage I–III, OR 1.25, 95% CI 1.21–1.29 p ‐value < 0.0001). Factors associated with overall survival (OS) in non‐operable patients included—sex ‐ male vs. female, HR 1.12 (95% CI 1.08–1.15); race ‐ Black vs. White, HR 1.23 (95% CI 1.06–1.42); income group ‐ lowest vs. highest, HR 1.33 (95% CI 1.27–1.39), and treatment center type ‐ academic vs. nonacademic center, HR 0.87 (95% CI 0.85–0.90). Conclusions Socioeconomic factors significantly impact incidence and outcomes for young‐onset pancreaticobiliary adenocarcinoma (YO‐PBA). More work is needed to help understand the mechanisms involved while addressing the disparities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of characteristics and outcomes of young‐onset versus average onset pancreatico‐biliary adenocarcinoma

et al. 2023

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“…In a U.S. registry study of 108,058 eoCRC, 65 black patients had a worse median OS than whites (58.3 vs 67.0 months; P < .0001).…”

Section: Le: 2bmentioning

confidence: 97%

“…In the United States, black individuals have a higher CRC incidence and mortality compared with other racial and ethnic groups. 15,65 However, the recent increase in eoCRC is largely driven by an increase in rectal cancer among white males. [66][67][68][69][70] Some studies have proposed other risk factors for eoCRC, including male sex, hyperlipidemia, obesity (especially during adolescence), metabolic syndrome, alcohol consumption, type II diabetes, and high intake of simple sugars.…”

Section: Genetics Of Early-onset Colorectal Cancer (G)mentioning

confidence: 99%

“…The systematic review found 6 studies evaluating the risk of eoCRC among different ethnicities, with 2 studies having LE 1b. They all concluded that black individuals have a higher risk of eoCRC, but the incidence and prevalence of eoCRC have remained the A full summary of relevant evidence for R.1 21,30,31,39,42,47,51,53,54,56,59,74,76,78,[90][91][92][93][94][95][96][97][98][99][100][101][102] and R. 29,30,31,36,[65][66][67][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85]…”

Section: Genetics Of Early-onset Colorectal Cancer (G)mentioning

confidence: 99%

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Delphi Initiative for Early-Onset Colorectal Cancer (DIRECt) International Management Guidelines

Giulia

Mannucci

Balaguer

et al. 2023

Clinical Gastroenterology and Hepatology

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Racial and Ethnic Variation in Survival in Early-Onset Colorectal Cancer

Demb,

Gomez,

Canchola

et al. 2024

JAMA Netw Open

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ImportanceRates of early-onset (before 50 years of age) colorectal cancer (EOCRC) are increasing, with notable differences across racial and ethnic groups. Limited data are available on EOCRC-related mortality differences when disaggregating racial and ethnic groups.ObjectiveTo investigate racial and ethnic differences in EOCRC mortality, including disaggregation of Asian American populations separately, including Native Hawaiian or Other Pacific Islander populations and specific Asian American groups, and to quantify the contribution of clinical and sociodemographic factors accounting for these differences.Design, Setting, and ParticipantsThis population-based cohort study included California Cancer Registry data for individuals aged 18 to 49 years with EOCRC between January 1, 2000, to December 31, 2019. Median follow-up was 4.2 (IQR, 1.6-10.0) years. The data analysis was conducted between July 1, 2021, and September 30, 2024.ExposureRace and ethnicity defined as Asian American (and 7 disaggregated subgroups), Hispanic, Native Hawaiian or Other Pacific Islander, non-Hispanic American Indian or Alaska Native, non-Hispanic Black, and non-Hispanic White.Main Outcomes and MeasuresCox proportional hazards regression models were used to measure association between race and ethnicity and CRC mortality risk, yielding adjusted hazard ratios (AHRs) and 95% CIs. Associations of sociodemographic, health system, and clinical factors with differences in mortality by racial and ethnic minority group were assessed using sequential modeling.ResultsThere were 22 834 individuals diagnosed with EOCRC between 2000 and 2019 (12 215 [53.5%] male; median age, 44 [IQR, 39-47] years). Racial and ethnic identity included 3544 (15.5%) Asian American, 6889 (30.2%) Hispanic, 135 (0.6%) Native Hawaiian or Other Pacific Islander, 125 (0.5%) non-Hispanic American Indian or Alaska Native, 1668 (7.3%) non-Hispanic Black, and 10 473 (45.9%) non-Hispanic White individuals. Compared with non-Hispanic White individuals, higher EOCRC mortality was found for Native Hawaiian or Other Pacific Islander (AHR, 1.34; 95% CI, 1.01-1.76) and non-Hispanic Black (AHR, 1.18; 95% CI, 1.07-1.29) individuals. Disaggregation of Asian American ethnic groups revealed notable heterogeneity, but no single group had increased EOCRC mortality risk after full adjustment for covariates. For Hispanic individuals, there was higher EOCRC mortality (AHR, 1.15 [95% CI, 1.08-1.22]) with the base model (adjustment for age, sex, and tumor characteristics), but the association disappeared once neighborhood socioeconomic status was added to the base model (AHR, 1.00 [95% CI, 0.94-1.06]). Similarly, there was higher EOCRC mortality among Southeast Asian individuals with the base model (AHR, 1.17 [95% CI, 1.03-1.34], but that association disappeared with the addition of insurance status to the model (AHR, 1.10 [95% CI, 0.96-1.25]).Conclusions and RelevanceIn this cohort study, racial and ethnic disparities in EOCRC mortality were evident, with the highest burden among Native Hawaiian or Other Pacific Islander and non-Hispanic Black individuals. These results provide evidence of the role of social determinants of health in explaining these differences.

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Racial disparities negatively impact outcomes in early‐onset colorectal cancer independent of socioeconomic status

Cited by 33 publications

References 38 publications

Comparison of characteristics and outcomes of young‐onset versus average onset pancreatico‐biliary adenocarcinoma

Comparison of characteristics and outcomes of young‐onset versus average onset pancreatico‐biliary adenocarcinoma

Delphi Initiative for Early-Onset Colorectal Cancer (DIRECt) International Management Guidelines

Racial and Ethnic Variation in Survival in Early-Onset Colorectal Cancer

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