Ethnic disparity in mortality after diagnosis of colorectal cancer among inner city minority New Yorkers.

ABSTRACT

BACKGROUND: Ethnic disparities in colorectal cancer (CRC) mortality are observed in the United States. The authors studied this among minority New Yorkers with CRC. METHODS: In a study of CRC patients in a New York City teaching hospital, 5-year data on demographics and clinical features were reviewed. Adjusted cancer-related deaths and early deaths (within 6 months of diagnosis) were compared among African Americans (AAs) and Hispanics. Descriptive analyses, odds ratios (ORs), and 95% confidence intervals (CIs) are reported. A P value of <.05 was considered significant. RESULTS: Among 202 CRC subjects, we noted the following Hispanics, 148 (73%); AAs, 54 (27%); women, 107 (53%); mean age, 64.5 years; and screening colonoscopy, 44 (22%). CRC was diagnosed by colonoscopy in 157 (78%) and by surgery in 45 (22%) cases. One hundred twenty-two (60%) had stage 0-II CRC, and 69 (34%) had proximal colonic lesions. Fifty-four of 202 patients died during the study period (median, 27 months), of whom 24 (11.9%) were early deaths. Significantly higher odds of death (OR, 3.98; 95% CI, 2.03-7.81), especially early death (OR, 5.94; 95% CI, 2.42-14.6) was observed among AAs. There was no difference in demographic and other clinical features, or treatment between Hispanics and AAs (P = nonsignificant). CONCLUSIONS: The first to compare inner city minority subjects with CRC, the authors observed increased odds of death in AAs, despite similar clinical features and living environment. Tumor behavior or host response among AAs could explain this difference. Aggressive therapeutic and early detection strategies need to be tested in a large randomized study setting to substantiate our study findings.