1. Exploring the complexity and spectrum of racial/ethnic disparities in colon cancer management
- Author
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Anya L. Greenberg, Nathan R. Brand, Alan Zambeli-Ljepović, Katherine E. Barnes, Sy Han Chiou, Kim F. Rhoads, Mohamed A. Adam, and Ankit Sarin
- Subjects
Male ,Native Hawaiian or Other Pacific Islander ,Health Services Accessibility ,Databases ,South Asian People ,Sociology ,Colorectal surgery ,Clinical Research ,Ethnicity ,Humans ,Racial disparities ,Healthcare Disparities ,Factual ,American Indian or Alaska Native ,Cancer ,Asian ,Health Policy ,Prevention ,Racial Groups ,Public Health, Environmental and Occupational Health ,East Asian People ,Southeast Asian People ,Hispanic or Latino ,Healthcare access ,United States ,Race Factors ,Colon cancer ,Colo-Rectal Cancer ,Black or African American ,Treatment Outcome ,Good Health and Well Being ,Colonic Neoplasms ,Public Health and Health Services ,Female ,Public Health ,Digestive Diseases - Abstract
Background Colorectal cancer is a leading cause of morbidity and mortality across U.S. racial/ethnic groups. Existing studies often focus on a particular race/ethnicity or single domain within the care continuum. Granular exploration of disparities among different racial/ethnic groups across the entire colon cancer care continuum is needed. We aimed to characterize differences in colon cancer outcomes by race/ethnicity across each stage of the care continuum. Methods We used the 2010–2017 National Cancer Database to examine differences in outcomes by race/ethnicity across six domains: clinical stage at presentation; timing of surgery; access to minimally invasive surgery; post-operative outcomes; utilization of chemotherapy; and cumulative incidence of death. Analysis was via multivariable logistic or median regression, with select demographics, hospital factors, and treatment details as covariates. Results 326,003 patients (49.6% female, 24.0% non-White, including 12.7% Black, 6.1% Hispanic/Spanish, 1.3% East Asian, 0.9% Southeast Asian, 0.4% South Asian, 0.3% AIAE, and 0.2% NHOPI) met inclusion criteria. Relative to non-Hispanic White patients: Southeast Asian (OR 1.39, p p p p p = 0.05), Hispanic/Spanish (OR 1.05 p = 0.02), and Black (OR 1.05, p p p p p p = 0.05). Black patients had significantly higher cumulative incidence of death at every pathologic stage relative to non-Hispanic White patients when adjusting for non-modifiable patient factors (p Conclusions Non-White patients disproportionately experience advanced stage at presentation. Disparities for Black patients are seen across the entire colon cancer care continuum. Targeted interventions may be appropriate for some groups; however, major system-level transformation is needed to address disparities experienced by Black patients.
- Published
- 2023