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Racial disparities in colorectal cancer outcomes and access to care: a multi-cohort analysis.
Riviere, Paul; Morgan, Kylie M; Deshler, Leah N; Demb, Joshua; Mehtsun, Winta T; Martinez, Maria Elena; Gupta, Samir; Banegas, Matthew; Murphy, James D; Rose, Brent S.
Afiliación
  • Riviere P; Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, United States.
  • Morgan KM; Center for Health Equity Education & Research (CHEER), University of California, San Diego, La Jolla, CA, United States.
  • Deshler LN; Veterans Affairs San Diego, La Jolla, CA, United States.
  • Demb J; Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, United States.
  • Mehtsun WT; Center for Health Equity Education & Research (CHEER), University of California, San Diego, La Jolla, CA, United States.
  • Martinez ME; Veterans Affairs San Diego, La Jolla, CA, United States.
  • Gupta S; Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, United States.
  • Banegas M; Center for Health Equity Education & Research (CHEER), University of California, San Diego, La Jolla, CA, United States.
  • Murphy JD; Veterans Affairs San Diego, La Jolla, CA, United States.
  • Rose BS; Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, United States.
Front Public Health ; 12: 1414361, 2024.
Article en En | MEDLINE | ID: mdl-38962767
ABSTRACT

Introduction:

Non-Hispanic Black (NHB) Americans have a higher incidence of colorectal cancer (CRC) and worse survival than non-Hispanic white (NHW) Americans, but the relative contributions of biological versus access to care remain poorly characterized. This study used two nationwide cohorts in different healthcare contexts to study health system effects on this disparity.

Methods:

We used data from the Surveillance, Epidemiology, and End Results (SEER) registry as well as the United States Veterans Health Administration (VA) to identify adults diagnosed with colorectal cancer between 2010 and 2020 who identified as non-Hispanic Black (NHB) or non-Hispanic white (NHW). Stratified survival analyses were performed using a primary endpoint of overall survival, and sensitivity analyses were performed using cancer-specific survival.

Results:

We identified 263,893 CRC patients in the SEER registry (36,662 (14%) NHB; 226,271 (86%) NHW) and 24,375 VA patients (4,860 (20%) NHB; 19,515 (80%) NHW). In the SEER registry, NHB patients had worse OS than NHW patients median OS of 57 months (95% confidence interval (CI) 55-58) versus 72 months (95% CI 71-73) (hazard ratio (HR) 1.14, 95% CI 1.12-1.15, p = 0.001). In contrast, VA NHB median OS was 65 months (95% CI 62-69) versus NHW 69 months (95% CI 97-71) (HR 1.02, 95% CI 0.98-1.07, p = 0.375). There was significant interaction in the SEER registry between race and Medicare age eligibility (p < 0.001); NHB race had more effect in patients <65 years old (HR 1.44, 95% CI 1.39-1.49, p < 0.001) than in those ≥65 (HR 1.13, 95% CI 1.11-1.15, p < 0.001). In the VA, age stratification was not significant (p = 0.21).

Discussion:

Racial disparities in CRC survival in the general US population are significantly attenuated in Medicare-aged patients. This pattern is not present in the VA, suggesting that access to care may be an important component of racial disparities in this disease.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Negro o Afroamericano / Neoplasias Colorrectales / Programa de VERF / Población Blanca / Disparidades en Atención de Salud / Accesibilidad a los Servicios de Salud Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Front Public Health Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Negro o Afroamericano / Neoplasias Colorrectales / Programa de VERF / Población Blanca / Disparidades en Atención de Salud / Accesibilidad a los Servicios de Salud Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Front Public Health Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos