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Analysis of racial disparities in the treatment and outcomes of colorectal cancer in young adults
- Source :
- Cancer epidemiology. 63
- Publication Year :
- 2019
-
Abstract
- The incidence of colorectal cancer (CRC) in young adults is increasing. Minority populations with CRC are known to have worse survival outcomes. The aim of this study is to evaluate adults under age 50 years with CRC by race and ethnicity.Data were obtained from all US hospitals that contributed to the National Cancer Database (NCDB) between 2004 and 2013. Univariate and multivariable testing was done to identify factors associated with patient outcome. Kaplan-Meier analysis and Cox proportional hazards models were used for association between patient characteristics and survival.A total of 83,449 patients between 18 and 50 years of age were identified. Median age was 45 years (SD ± 6), with male preponderance (53.9%). 72% were non-Hispanic Whites (NHW), Blacks (AA) were 15.1% and Hispanics (who did not identify as Blacks) were 8.3% of the study population. Distribution across stages IIV was 15.6%, 22.4%, 33.9% and 27% consecutively. 41.8% of NHW and 28.4% of AA had rectal cancers (p 0.001). Despite equally receiving standard of care (SOC) as per national guidelines, AA had significantly lower 5-year survival rates (58.8%) compared to Hispanics (64.8%) and NHW (66.9%; HR 1.42; 1.38-1.46; p 0.001). Furthermore, NHW (HR 0.85; 0.81-0.88; p 0.001) and Hispanics (HR 0.75; 0.70-0.79; p 0.001) were more likely to benefit from chemotherapy compared to AA. SOC utilization was associated with improved survival across all racial groups, especially in AA (HR 0.64; 0.60-0.69; p 0.001).Despite comparable rates of SOC utilization, AA young adults had worse survival outcomes compared to other races. More colon (compared to rectal) cancers in AA may have contributed to their worse outcomes.
- Subjects :
- Adult
Male
Cancer Research
medicine.medical_specialty
Adolescent
Epidemiology
Colorectal cancer
Ethnic group
Black People
White People
03 medical and health sciences
Young Adult
0302 clinical medicine
Internal medicine
medicine
Humans
030212 general & internal medicine
Young adult
Healthcare Disparities
business.industry
Proportional hazards model
Incidence (epidemiology)
Cancer
Hispanic or Latino
Middle Aged
medicine.disease
Health equity
United States
Treatment Outcome
Oncology
030220 oncology & carcinogenesis
Population study
Female
business
Colorectal Neoplasms
Subjects
Details
- ISSN :
- 1877783X
- Volume :
- 63
- Database :
- OpenAIRE
- Journal :
- Cancer epidemiology
- Accession number :
- edsair.doi.dedup.....05f05e0ef0926e803de1f597eb254f6a