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Showing content from https://pubmed.ncbi.nlm.nih.gov/29146523/ below:

Factors That Contribute to Differences in Survival of Black vs White Patients With Colorectal Cancer

Observational Study

. 2018 Mar;154(4):906-915.e7. doi: 10.1053/j.gastro.2017.11.005. Epub 2017 Nov 14. Factors That Contribute to Differences in Survival of Black vs White Patients With Colorectal Cancer

Affiliations

¹ American Cancer Society, Atlanta, Georgia. Electronic address: helmneh.sineshaw@cancer.org.
² Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
³ American Cancer Society, Atlanta, Georgia; Emory University, Rollins School of Public Health, Atlanta, Georgia.
⁴ American Cancer Society, Atlanta, Georgia.

PMID: 29146523
PMCID: PMC5847437
DOI: 10.1053/j.gastro.2017.11.005

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Observational Study

Factors That Contribute to Differences in Survival of Black vs White Patients With Colorectal Cancer

Helmneh M Sineshaw et al. Gastroenterology. 2018 Mar.

. 2018 Mar;154(4):906-915.e7. doi: 10.1053/j.gastro.2017.11.005. Epub 2017 Nov 14. Affiliations

¹ American Cancer Society, Atlanta, Georgia. Electronic address: helmneh.sineshaw@cancer.org.
² Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
³ American Cancer Society, Atlanta, Georgia; Emory University, Rollins School of Public Health, Atlanta, Georgia.
⁴ American Cancer Society, Atlanta, Georgia.

PMID: 29146523
PMCID: PMC5847437
DOI: 10.1053/j.gastro.2017.11.005

Item in Clipboard

Abstract

Background & aims: Previous studies reported that black vs white disparities in survival among elderly patients with colorectal cancer (CRC) were because of differences in tumor characteristics (tumor stage, grade, nodal status, and comorbidity) rather than differences in treatment. We sought to determine the contribution of differences in insurance, comorbidities, tumor characteristics, and treatment receipt to disparities in black vs white patients with CRC 18-64 years old.

Methods: We used data from the National Cancer Database, a hospital-based cancer registry database sponsored by the American College of Surgeons and the American Cancer Society, on non-Hispanic black (black) and non-Hispanic white (white) patients, 18-64 years old, diagnosed from 2004 through 2012 with single or first primary invasive stage I-IV CRC. Each black patient was matched, based on demographic, insurance, comorbidity, tumor, and treatment features, with 5 white patients, from partially overlapping subgroups, using propensity score and greedy matching algorithms. We used the Kaplan-Meier method to estimate 5-year survival and Cox proportional hazards models to generate hazard ratios.

Results: The absolute 5-year survival difference between black and white unmatched patients with CRC was 9.2% (57.3% for black patients vs 66.5% for white patients; P < .0001). The absolute difference in survival did not change after patient groups were matched for demographics, but decreased to 4.9% (47% relative decrease [4.3% of 9.2%]) when they were matched for insurance and to 2.3% when they were matched for tumor characteristics (26% relative decrease [2.4% of 9.2%]). Further matching by treatment did not reduce the difference in 5-year survival between black and white patients. In proportional hazards model, insurance and tumor characteristics matching accounted for the 54% and 27% excess risk of death in black patients, respectively.

Conclusions: In an analysis of data from the National Cancer Database, we found that insurance coverage differences accounted for approximately one half of the disparity in survival rate of black vs white patients with CRC, 18-64 years old; tumor characteristics accounted for a quarter of the disparity. Affordable health insurance coverage for all populations could substantially reduce differences in survival times of black vs white patients with CRC.

Keywords: Colon Cancer; Comorbidity; Mortality; Race.

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Conflict of interest statement

Conflict of Interest: The authors disclose no conflicts of interest.

Figures
Figure 1

Flow chart of cohort inclusion/exclusion…

Figure 1

Flow chart of cohort inclusion/exclusion criteria for 18–64 years old patients with stage…

Figure 1

Flow chart of cohort inclusion/exclusion criteria for 18–64 years old patients with stage I–IV colorectal cancer in the National Cancer Data Base (2004–2012).

Figure 2

Overall 5-year survival curves for…

Figure 2

Overall 5-year survival curves for 18–64 years old NH blacks and five sequentially…

Figure 2

Overall 5-year survival curves for 18–64 years old NH blacks and five sequentially matched 18–64 years old NH whites with colorectal cancer.

Figure 3

Hazard ratios of all-cause 5-year…

Figure 3

Hazard ratios of all-cause 5-year mortality risk for 18–64 years old NH blacks…

Figure 3

Hazard ratios of all-cause 5-year mortality risk for 18–64 years old NH blacks versus sequentially matched 18–64 years old NH whites for patients diagnosed with colorectal cancer Abbreviation: NH, non-Hispanic