This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Le, H. Articles by Zell, J. A. Search for Related Content PubMed PubMed Citation Articles by Le, H. Articles by Zell, J. A.

Effects of Socioeconomic Status and Treatment Disparities in Colorectal Cancer Survival

¹ Chao Family Comprehensive Cancer Center, Division of Hematology/Oncology, ² Genetic Epidemiology Research Institute, and ³ Department of Epidemiology, School of Medicine, University of California at Irvine, Irvine, California

Requests for reprints: Jason A. Zell, Department of Epidemiology, University of California at Irvine, 224 Irvine Hall, Irvine, CA 92697. Phone: 949-824-7401; Fax: 949-824-1343. E-mail: jzell{at}uci.edu

Background: Poor survival among colorectal cancer (CRC) cases has been associated with African-American race and low socioeconomic status (SES). However, it is not known whether the observed poor survival of African-American CRC cases is due to SES itself and/or treatment disparities. We set out to determine this using data from the large, population-based California Cancer Registry database.

Methods: A case-only analysis of CRC was conducted including all age groups using California Cancer Registry data from 1994 to 2003, including descriptive analysis of relevant clinical variables, race, and SES. CRC-specific survival univariate analyses were conducted using the Kaplan-Meier method. Multivariate survival analyses were done using Cox proportional hazards ratios (HR).

Results: Incident cases of colon (90,273) and rectal (37,532) cancer were analyzed, including 91,739 (71.8%) non-Hispanic Whites, 8,535 (6.7%) African-Americans, 14,943 (11.7%) Hispanics, 3,564 (2.8%) Chinese, and 7,950 (6.2%) non-Chinese Asians. African-Americans had a greater proportion of metastatic stage at presentation (P < 0.0001) and decreased CRC-specific survival (P < 0.0001 for colon and rectal cancer). After adjustment for age, sex, histology, site within the colon, and stage, African-Americans [colon: HR, 1.19; 95% confidence interval (95% CI), 1.14-1.25; rectum: HR, 1.27; 95% CI, 1.17-1.38] had an increased risk of death compared with Caucasians. However, after further adjustment for SES and treatment, the risk of death for African-Americans compared with Caucasians was substantially diminished (colon: HR, 1.08; 95% CI, 1.03-1.13; rectum: HR, 1.11; 95% CI, 1.02-1.20).

Conclusion: Among CRC cases, disparities in treatment and SES largely explain the observed decreased survival of African-Americans, underscoring the importance of health disparity research in this disease. (Cancer Epidemiol Biomarkers Prev 2008;17(8):1950–62)

This article has been cited by other articles:

				J. A. Zell, J. Honda, A. Ziogas, and H. Anton-Culver Survival After Colorectal Cancer Diagnosis Is Associated with Colorectal Cancer Family History Cancer Epidemiol. Biomarkers Prev., November 1, 2008; 17(11): 3134 - 3140. [Abstract] [Full Text] [PDF]