Racial differences in colorectal cancer survival in the Detroit Metropolitan area

Authors

  • Ben Yan MD,

    1. Department of Internal Medicine, Henry Ford Hospital and Medical Center, Detroit, Michigan
    Search for more papers by this author
  • Anne-Michelle Noone MS,

    1. Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC
    Search for more papers by this author
  • Cecilia Yee MS,

    1. Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan
    Search for more papers by this author
  • Mousumi Banerjee PhD,

    1. Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
    Search for more papers by this author
  • Kendra Schwartz MD, MSPH,

    1. Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan
    2. Department of Family Medicine & Public Health Sciences, Wayne State University, Detroit, Michigan
    Search for more papers by this author
  • Michael S. Simon MD, MPH

    Corresponding author
    1. Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan
    2. Division of Hematology and Oncology, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan
    • Barbara Ann Karmanos Cancer Institute, 4100 John R, Room 4221, Hudson Weber Cancer Research Center, Detroit, MI 48201
    Search for more papers by this author
    • Fax: (313) 576-8764


Abstract

BACKGROUND:

Colorectal carcinoma is the second most common cause of cancer death with African Americans having lower survival compared with White Americans. The purpose of this study was to investigate the effect of demographics, clinical factors, and socioeconomic status (SES) on racial disparities in colorectal cancer survival in the Detroit Metropolitan Area.

METHODS:

The study population included 9078 individuals with primary invasive colorectal cancer identified between 1988 and 1992 through the Surveillance, Epidemiology, and End Results (SEER) program. Demographics, clinical information, and survival were obtained through SEER. SES was categorized using occupation, educational level, and poverty status at the census tract level. Kaplan-Meier survival curves and Cox proportional hazards regression were used to compare overall survival by race.

RESULTS:

African Americans were more likely to be diagnosed with stage IV disease (P < .001), and to reside within poor census tracts (P < .001) compared with White Americans. Unadjusted analysis showed that African Americans had a significantly higher risk of death compared with their White American counterparts (hazards ratio [HR], 1.13; 95% confidence interval [CI], 1.07-1.20). After adjusting for age, marital status, sex, SES group, TNM stage, and treatment, race was no longer significantly associated with overall survival (HR, 1.00; 95% CI, 0.92-1.09). Similar results were seen with colorectal cancer-specific survival.

CONCLUSIONS:

Racial disparities in colorectal cancer survival dissipate after adjusting for other demographic and clinical factors. These results can potentially affect medical guidelines regarding screening and treatment, and possibly influence public health policies that can have a positive impact on equalizing racial differences in access to care. Cancer 2009. © 2009 American Cancer Society.

Ancillary