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Racial differences in colorectal cancer survival in the Detroit Metropolitan area

  1. Ben Yan MD1,
  2. Anne-Michelle Noone MS2,
  3. Cecilia Yee MS3,
  4. Mousumi Banerjee PhD4,
  5. Kendra Schwartz MD, MSPH3,5,
  6. Michael S. Simon MD, MPH3,6,†,*

Article first published online: 13 JUL 2009

DOI: 10.1002/cncr.24408

Issue

Cancer

Cancer

Volume 115, Issue 16, pages 3791–3800, 15 August 2009

Additional Information

How to Cite

Yan, B., Noone, A.-M., Yee, C., Banerjee, M., Schwartz, K. and Simon, M. S. (2009), Racial differences in colorectal cancer survival in the Detroit Metropolitan area. Cancer, 115: 3791–3800. doi: 10.1002/cncr.24408

Author Information

  1. 1

    Department of Internal Medicine, Henry Ford Hospital and Medical Center, Detroit, Michigan

  2. 2

    Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC

  3. 3

    Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan

  4. 4

    Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan

  5. 5

    Department of Family Medicine & Public Health Sciences, Wayne State University, Detroit, Michigan

  6. 6

    Division of Hematology and Oncology, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan

  1. †

    Fax: (313) 576-8764

*Barbara Ann Karmanos Cancer Institute, 4100 John R, Room 4221, Hudson Weber Cancer Research Center, Detroit, MI 48201

  1. †

    Fax: (313) 576-8764

Publication History

  1. Issue published online: 3 AUG 2009
  2. Article first published online: 13 JUL 2009
  3. Manuscript Accepted: 13 JAN 2009
  4. Manuscript Revised: 6 JAN 2009
  5. Manuscript Received: 26 SEP 2008

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Keywords:

  • survival;
  • colorectal cancer;
  • SEER;
  • racial disparities;
  • socioeconomic status

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.

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