Racial disparities and socioeconomic status in association with survival in a large population‐based cohort of elderly patients with colon cancer

Abstract

BACKGROUND.To the authors' knowledge, few studies have addressed racial disparities in the survival of patients with colon cancer by adequately incorporating treatment and socioeconomic factors in addition to patient and tumor characteristics.METHODS.The authors studied a nationwide and population‐based, retrospective cohort of 18,492 men and women who were diagnosed with stage II or III colon cancer at age ≥65 years between 1992 and 1999. This cohort was identified from the Surveillance, Epidemiology, and End Results (SEER) cancer registries‐Medicare linked databases and included up to 11 years of follow‐up.RESULTS.A larger proportion (70%) of African‐American patients with colon cancer fell into the poorest quartiles of socioeconomic status compared with Caucasians (21%). Patients who lived in communities with the lowest socioeconomic level had 19% higher all‐cause mortality compared with patients who lived in communities with the highest socioeconomic status (hazards ratio [HR], 1.19; 95% confidence interval [95% CI], 1.13–1.26; P < .001 for trend). The risk of dying was reduced only slightly after controlling for race/ethnicity (HR, 1.17; 95% CI, 1.10–1.24). Compared with Caucasian patients with colon cancer, African‐American patients were 21% more likely to die after controlling for age, sex, comorbidity scores, tumor stage, and grade (HR, 1.21; 95% CI, 1.12–1.30). After also adjusting for definitive therapy and socioeconomic status, the HR of mortality was only marginally significantly higher in African Americans compared with Caucasians for all‐cause mortality (HR, 1.10; 95% CI, 1.02–1.19) and colon cancer‐specific mortality (HR, 1.16; 95% CI, 1.01–1.33).CONCLUSIONS.Lower socioeconomic status and lack of definitive treatment were associated strongly with decreased survival in both men and women with colon cancer. Racial disparities in survival were explained substantially by differences in socioeconomic status. Cancer 2007. © 2007 American Cancer Society.

Disparities in Breast Cancer Treatment and Outcomes: Biological, Social, and Health System Determinants and Opportunities for Research

“…Social factors, including poverty and financial insecurity, lack of transportation, poor access to care, poor health literacy, low educational attainment, and lack of health insurance contribute substantially to differences in breast cancer outcomes [5,9,12,[51][52][53][54][55][56]. Lower income and uninsured cancer patients are especially sensitive to the high costs of cancer care and may be more likely to be from minority groups [57].…”

Utilization of Hepatocellular Carcinoma Surveillance Among American Patients: A Systematic Review

“…Several studies have reported lower rates of curative therapies being offered, whereas others have postulated biologic differences in tumor behavior. 16,[17][18][19] The potential role of differences in surveillance utilization rates has been well documented for other cancer screening modalities, such as mammography and colonoscopy, [20][21][22][23] but not for HCC surveillance. The purpose of our study was to 1) quantify utilization rates for HCC surveillance among patients with cirrhosis in the United States and 2) to summarize patterns of association between utilization rates and patient sociodemographic characteristics.…”

Effects of Socioeconomic Status and Treatment Disparities in Colorectal Cancer Survival

“…A recent meta-analysis by Du et al (16) revealed that studies taking into account SES and survival in colon cancer have been relatively small and inconsistent. Larger population-based studies are limited to older populations and those with regional-staged disease (17). We set out to determine how differences in SES and treatment affect racial disparities in survival of colon and rectal cancer patients through a case-only analysis of data from the large, population-based California Cancer Registry (CCR).…”