Racial disparities in colorectal cancer outcomes and access to care

A multi-cohort analysis

Bibliographic Data

ID22074381
AuthorsPaul Riviere (0000-0001-7966-3090, University of California San Diego, corresponding author), Kylie M Morgan, Kylie Morgan (0000-0002-2776-2721, University of California San Diego), Leah N Deshler (University of California San Diego), Joshua Demb (0000-0002-3338-1730, University of California San Diego), Winta T Mehtsun (0000-0002-0097-1881, University of California San Diego), Maria Elena Martinez (0000-0002-8120-1108, University of California San Diego), Samir Gupta (0000-0002-7307-6247, University of California San Diego), Matthew P Banegas (0000-0002-6158-7162, University of California San Diego), Matthew Banegas, James D Murphy (0009-0008-1719-5111, University of California San Diego), Brent S Rose (0000-0002-3197-9552, University of California San Diego)
Year2024
Volume12
Pages1414361-1414361
Publication date2024-06-19
Open AccessYes
TypeARTICLE
VenueFrontiers in Public Health (JOURNAL)
Journal identifiersISSN: 2296-2565 • E-ISSN: 2296-2565
PublisherFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2024.1414361
PMID38962767
OpenAlexW4399817277
LanguageEN
Citations received2
References cited22

Introduction Non-Hispanic Black (NHB) Americans have a higher incidence of colorectal cancer (CRC) and worse survival than non-Hispanic white (NHW) Americans, but the relative contributions of biological versus access to care remain poorly characterized. This study used two nationwide cohorts in different healthcare contexts to study health system effects on this disparity. Methods We used data from the Surveillance, Epidemiology, and End Results (SEER) registry as well as the United States Veterans Health Administration (VA) to identify adults diagnosed with colorectal cancer between 2010 and 2020 who identified as non-Hispanic Black (NHB) or non-Hispanic white (NHW). Stratified survival analyses were performed using a primary endpoint of overall survival, and sensitivity analyses were performed using cancer-specific survival. Results We identified 263,893 CRC patients in the SEER registry (36,662 (14%) NHB; 226,271 (86%) NHW) and 24,375 VA patients (4,860 (20%) NHB; 19,515 (80%) NHW). In the SEER registry, NHB patients had worse OS than NHW patients: median OS of 57 months (95% confidence interval (CI) 55–58) versus 72 months (95% CI 71–73) (hazard ratio (HR) 1.14, 95% CI 1.12–1.15, p = 0.001). In contrast, VA NHB median OS was 65 months (95% CI 62–69) versus NHW 69 months (95% CI 97–71) (HR 1.02, 95% CI 0.98–1.07, p = 0.375). There was significant interaction in the SEER registry between race and Medicare age eligibility ( p < 0.001); NHB race had more effect in patients <65 years old (HR 1.44, 95% CI 1.39–1.49, p < 0.001) than in those ≥65 (HR 1.13, 95% CI 1.11–1.15, p < 0.001). In the VA, age stratification was not significant ( p = 0.21). Discussion Racial disparities in CRC survival in the general US population are significantly attenuated in Medicare-aged patients. This pattern is not present in the VA, suggesting that access to care may be an important component of racial disparities in this disease

Cancer · Cancer registry · Cohort · Cohort study · Colorectal cancer · Confidence interval · Hazard ratio · Surveillance, Epidemiology, and End Results · Colorectal Cancer Screening and Detection · Economic and Financial Impacts of Cancer · Global Cancer Incidence and Screening · Medicine · Epidemiology · Gerontology · Internal Medicine

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