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Racial differences in tumor stage and survival for colorectal cancer in an insured population†

  1. Chyke A. Doubeni MD, MPH1,2,‡,*,
  2. Terry S. Field DSc2,
  3. Diana S.M. Buist PhD3,
  4. Eli J. Korner PharmD, MPH4,
  5. Carol Bigelow PhD5,
  6. Lois Lamerato PhD6,
  7. Lisa Herrinton PhD7,
  8. Virginia P. Quinn PhD8,
  9. Gene Hart MS3,
  10. Mark C. Hornbrook PhD9,
  11. Jerry H. Gurwitz MD2,
  12. Edward H. Wagner MD, MPH3

Article first published online: 21 DEC 2006

DOI: 10.1002/cncr.22437

Issue

Cancer

Cancer

Volume 109, Issue 3, pages 612–620, 1 February 2007

Additional Information

How to Cite

Doubeni, C. A., Field, T. S., Buist, D. S., Korner, E. J., Bigelow, C., Lamerato, L., Herrinton, L., Quinn, V. P., Hart, G., Hornbrook, M. C., Gurwitz, J. H. and Wagner, E. H. (2007), Racial differences in tumor stage and survival for colorectal cancer in an insured population. Cancer, 109: 612–620. doi: 10.1002/cncr.22437

Author Information

  1. 1

    Department of Family Medicine and Community Health, University of Massachusetts, Worcester, Massachusetts

  2. 2

    Meyers Primary Care Institute; University of Massachusetts Medical School, Fallon Clinic Foundation, and Fallon Community Health Plan, Worcester, Massachusetts

  3. 3

    Group Health Center for Health Studies, Kaiser Permanente Southern California, Pasadena, California

  4. 4

    Clinical Research Unit, Kaiser Permanente, Aurora, Colorado

  5. 5

    Program in Biostatistics and Epidemiology, School of Public Health, University of Massachusetts, Amherst, Massachusetts

  6. 6

    Center for Health Services Research, Henry Ford Health System, Detroit, Michigan

  7. 7

    Division of Research, Kaiser Permanente Northern California, Oakland, California

  8. 8

    Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, California

  9. 9

    Center for Health Research, Northwest/Hawaii, Kaiser Permanente Northwest, Portland, Oregon

  1. ‡

    Fax: (508) 856-1212

*Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655

  1. †

    This research was made possible by the cooperation of the participating Cancer Research Network members. We are particularly grateful to Donald J. Bachman, MS; Jennifer Ellis, MSPH; Hassan Fouayzi, MS; Rick Krajenta; Liyan Liu, MSPH; Janis Yao, MS; and Fagen Xie, PhD, whose collective work in building the Cancer Research Network's Virtual Data Warehouse made this research project possible.

Publication History

  1. Issue published online: 19 JAN 2007
  2. Article first published online: 21 DEC 2006
  3. Manuscript Accepted: 9 NOV 2006
  4. Manuscript Revised: 6 NOV 2006
  5. Manuscript Received: 24 AUG 2006

Funded by

  • Funding from the National Cancer Institute to the Cancer Research Network. Grant Number: U19 CA079689
  • National Cancer Institute to the Cancer Research Network. Grant Number: U19 CA079689-06
  • American Cancer Society. Grant Number: CRTG-03-024-01-CCE

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Keywords:

  • race;
  • disparities;
  • cancer;
  • colon/rectum;
  • stage;
  • survival;
  • insurance

The results from this study indicated the presence of complex racial disparities for colorectal cancer in patients who received care in integrated health care systems despite the availability of health insurance and the potential for a regular source of preventive health care. The disparities in survival were related to differences in tumor stage and the receipt of cancer-related therapies but did not appear to be related to differences in comorbidity.

Abstract

BACKGROUND.

Despite declining death rates from colorectal cancer (CRC), racial disparities have continued to increase. In this study, the authors examined disparities in a racially diverse group of insured patients.

METHODS.

This study was conducted among patients who were diagnosed with CRC from 1993 to 1998, when they were enrolled in integrated healthcare systems. Patients were identified from tumor registries and were linked to information in administrative databases. The sample was restricted to non-Hispanic whites (n = 10,585), non-Hispanic blacks (n = 1479), Hispanics (n = 985), and Asians/Pacific Islanders (n = 909). Differences in tumor stage and survival were analyzed by using polytomous and Cox regression models, respectively.

RESULTS.

In multivariable regression analyses, blacks were more likely than whites to have distant or unstaged tumors. In Cox models that were adjusted for nonmutable factors, blacks had a higher risk of death from CRC (hazard ratio [HR], 1.17; 95% confidence interval [95% CI], 1.06–1.30). Hispanics had a risk of death similar to whites (HR, 1.04; 95% CI, 0.92–1.18), whereas Asians/Pacific Islanders had a lower risk of death from CRC (HR, 0.89; 95% CI, 0.78–1.02). Adjustment for tumor stage decreased the HR to 1.11 for blacks, and the addition of receipt of surgical therapy to the model decreased the HR further to 1.06. The HR among Hispanics and Asians/Pacific Islanders was stable to adjustment for tumor stage and surgical therapy.

CONCLUSIONS.

The relation between race and survival from CRC was complex and appeared to be related to differences in tumor stage and therapy received, even in insured populations. Targeted interventions to improve the use of effective screening and treatment among vulnerable populations may be needed to eliminate disparities in CRC. Cancer 2007;109:612–620. © 2006 American Cancer Society.

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