Changes in Colorectal Cancer 5-Year Survival Disparities in California, 1997-2014.


Journal

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
ISSN: 1538-7755
Titre abrégé: Cancer Epidemiol Biomarkers Prev
Pays: United States
ID NLM: 9200608

Informations de publication

Date de publication:
06 2020
Historique:
received: 12 12 2019
revised: 10 02 2020
accepted: 27 03 2020
pubmed: 7 5 2020
medline: 16 9 2021
entrez: 7 5 2020
Statut: ppublish

Résumé

Colorectal cancer incidence and mortality have declined with increased screening and scientific advances in treatment. However, improvement in colorectal cancer outcomes has not been equal for all groups and disparities have persisted over time. Data from the California Cancer Registry were used to estimate changes in 5-year colorectal cancer-specific survival over three diagnostic time periods: 1997-2002, 2003-2008, and 2009-2014. Analyses included all patients in California with colorectal cancer as a first primary malignancy. Multivariable Cox proportional hazard regression models were used to evaluate the effect of race/ethnicity, insurance status, and neighborhood socioeconomic status (nSES) on 5-year colorectal cancer-specific survival. On the basis of a population-based sample of 197,060 colorectal cancer cases, racial/ethnic survival disparities decreased over time among non-Hispanic Blacks (NHB) compared with non-Hispanic Whites (NHW), after adjusting for demographic, clinical, and treatment characteristics. For cases diagnosed 1997-2002, colorectal cancer-specific hazard rates were higher for NHB [HR, 1.12; 95% confidence interval (CI), 1.06-1.19] and lower for Asians/Pacific Islanders (HR, 0.92; 95% CI, 0.87-0.96) and Hispanics (HR, 0.94; 95% CI, 0.90-0.99) compared with NHW. In 2009-2014, colorectal cancer-specific HR for NHB was not significantly different to the rate observed for NHW (HR, 1.03; 95% CI, 0.97-1.10). There were no changes in disparities in nSES, but increasing disparities by health insurance status. We found a decrease in survival disparities over time by race/ethnicity, but a persistence of disparities by neighborhood socioeconomic status and health insurance status. Further investigation into the drivers for these disparities can help direct policy and practice toward health equity for all groups.

Sections du résumé

BACKGROUND
Colorectal cancer incidence and mortality have declined with increased screening and scientific advances in treatment. However, improvement in colorectal cancer outcomes has not been equal for all groups and disparities have persisted over time.
METHODS
Data from the California Cancer Registry were used to estimate changes in 5-year colorectal cancer-specific survival over three diagnostic time periods: 1997-2002, 2003-2008, and 2009-2014. Analyses included all patients in California with colorectal cancer as a first primary malignancy. Multivariable Cox proportional hazard regression models were used to evaluate the effect of race/ethnicity, insurance status, and neighborhood socioeconomic status (nSES) on 5-year colorectal cancer-specific survival.
RESULTS
On the basis of a population-based sample of 197,060 colorectal cancer cases, racial/ethnic survival disparities decreased over time among non-Hispanic Blacks (NHB) compared with non-Hispanic Whites (NHW), after adjusting for demographic, clinical, and treatment characteristics. For cases diagnosed 1997-2002, colorectal cancer-specific hazard rates were higher for NHB [HR, 1.12; 95% confidence interval (CI), 1.06-1.19] and lower for Asians/Pacific Islanders (HR, 0.92; 95% CI, 0.87-0.96) and Hispanics (HR, 0.94; 95% CI, 0.90-0.99) compared with NHW. In 2009-2014, colorectal cancer-specific HR for NHB was not significantly different to the rate observed for NHW (HR, 1.03; 95% CI, 0.97-1.10). There were no changes in disparities in nSES, but increasing disparities by health insurance status.
CONCLUSIONS
We found a decrease in survival disparities over time by race/ethnicity, but a persistence of disparities by neighborhood socioeconomic status and health insurance status.
IMPACT
Further investigation into the drivers for these disparities can help direct policy and practice toward health equity for all groups.

Identifiants

pubmed: 32371552
pii: 1055-9965.EPI-19-1544
doi: 10.1158/1055-9965.EPI-19-1544
pmc: PMC7269803
mid: NIHMS1581975
doi:

Types de publication

Historical Article Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.

Langues

eng

Sous-ensembles de citation

IM

Pagination

1154-1161

Subventions

Organisme : NCI NIH HHS
ID : HHSN261201800032C
Pays : United States
Organisme : NCI NIH HHS
ID : HHSN261201800009C
Pays : United States
Organisme : NCCDPHP CDC HHS
ID : NU58DP006344
Pays : United States
Organisme : NCI NIH HHS
ID : HHSN261201800015I
Pays : United States
Organisme : NIA NIH HHS
ID : T32 AG049663
Pays : United States
Organisme : NCI NIH HHS
ID : HHSN261201800032I
Pays : United States
Organisme : NCI NIH HHS
ID : HHSN261201800015C
Pays : United States
Organisme : NCI NIH HHS
ID : HHSN261201800009I
Pays : United States

Informations de copyright

©2020 American Association for Cancer Research.

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Auteurs

Debora L Oh (DL)

Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California. Debora.Oh@ucsf.edu.
Greater Bay Area Cancer Registry, University of California, San Francisco, San Francisco, California.

Eduardo J Santiago-Rodríguez (EJ)

Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.

Alison J Canchola (AJ)

Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
Greater Bay Area Cancer Registry, University of California, San Francisco, San Francisco, California.

Libby Ellis (L)

London School of Hygiene and Tropical Medicine, London, United Kingdom.

Li Tao (L)

Greater Bay Area Cancer Registry, University of California, San Francisco, San Francisco, California.

Scarlett L Gomez (SL)

Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
Greater Bay Area Cancer Registry, University of California, San Francisco, San Francisco, California.

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Classifications MeSH