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Racial disparity in death from colorectal cancer

Does vitamin D deficiency contribute?

  1. Kevin Fiscella MD, MPH1,2,†,*,
  2. Paul Winters MS1,
  3. Daniel Tancredi PhD3,4,
  4. Samantha Hendren MD, MPH5,
  5. Peter Franks MD3,6

Article first published online: 13 OCT 2010

DOI: 10.1002/cncr.25647

Issue

Cancer

Cancer

Volume 117, Issue 5, pages 1061–1069, 1 March 2011

Additional Information

How to Cite

Fiscella, K., Winters, P., Tancredi, D., Hendren, S. and Franks, P. (2011), Racial disparity in death from colorectal cancer. Cancer, 117: 1061–1069. doi: 10.1002/cncr.25647

Author Information

  1. 1

    Department of Family Medicine, University of Rochester, Rochester, New York

  2. 2

    Department of Community and Preventive Medicine, University of Rochester, Rochester, New York

  3. 3

    Center for Healthcare Policy and Research, University of California at Davis, Davis, California

  4. 4

    Department of Pediatrics, University of California at Davis, Davis, California

  5. 5

    Department of Surgery, Colorectal Division, University of Michigan School of Medicine, Ann Arbor, Michigan

  6. 6

    Department of Family and Community Medicine, University of California at Davis, Davis, California

  1. †

    Fax: (585) 473-2245

*Department of Family Medicine, University of Rochester, 1381 South Avenue, Rochester, NY 14620

  1. †

    Fax: (585) 473-2245

Publication History

  1. Issue published online: 18 FEB 2011
  2. Article first published online: 13 OCT 2010
  3. Manuscript Accepted: 9 AUG 2010
  4. Manuscript Revised: 6 JUL 2010
  5. Manuscript Received: 12 MAY 2010

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Keywords:

  • disparities;
  • colorectal cancer;
  • vitamin D;
  • minorities;
  • income;
  • poverty

Abstract

BACKGROUND:

The reasons blacks have higher mortality rates from colorectal cancer (CRC) than non-Hispanic whites are not fully understood. Blacks have higher rates of vitamin D deficiency than non-Hispanic whites, and vitamin D deficiency has been associated with CRC. The authors of this report investigated the association of vitamin D deficiency with excess risk for CRC mortality for blacks in the Third National Health and Nutrition Examination Survey (NHANES III) that was conducted from 1988 to 1994.

METHODS:

The association between serum 25(OH)D levels and CRC mortality and its contribution to elevated risk among blacks were studied using baseline data from NHANES III and CRC mortality data through 2006 from the National Death Index. By using survival models, the adjusted risk of death from CRC for African Americans was examined with and without adjusting for vitamin D deficiency, which was defined as an 25(OH)D level <20 ng/dL.

RESULTS:

Black race (hazard ratio [HR], 2.03; 95% confidence interval [95% CI], 1.04-3.95), age (HR, 1.12; 95% CI, 1.09-1.15), not having health insurance (HR, 2.45; 95% CI, 1.12-5.36), and a history of CRC (HR, 7.22; 95% CI, 2.12-24.6) predicted CRC mortality. When added to the model, vitamin D deficiency was associated significantly with CRC mortality (HR, 2.11; 95% CI, 1.11-4.00), and the effect of race was decreased (HR, 1.60; 95% CI, 0.87-2.93); the 40% attenuation was statistically significant (F1,49 = 4.85; P = .03). Similar results were observed when participants who had a history of CRC were excluded from the analysis.

CONCLUSIONS:

The current findings were consistent with the hypothesis that vitamin D deficiency contributes to excess African-American mortality from CRC. Cancer 2011. © 2010 American Cancer Society.

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