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Racial disparities in advanced-stage colorectal cancer survival

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Abstract

Purpose

African-Americans (AA) have a higher incidence of and lower survival from colorectal cancer (CRC) compared with European Americans (EA). In the present study, statewide, population-based data from South Carolina Central Cancer Registry are used to investigate the relationship between race and age on advanced-stage CRC survival.

Methods

The study population was comprised of 3,865 advanced pathologically documented colon and rectal adenocarcinoma cases diagnosed between 01 January 1996 and 31 December 2006: 2,673 (69 %) EA and 1,192 (31 %) AA. Kaplan–Meier methods were used to generate median survival time and corresponding 95 % confidence intervals (CI) by race, age, and gender. Factors associated with survival were evaluated by fitting Cox proportional hazards regression models to generate hazard ratios (HR) and 95 % CI.

Results

We observed a significant interaction between race and age on CRC survival (p = 0.04). Among younger patients (<50 years), AA race was associated with a 1.34 times (95 % CI 1.06–1.71) higher risk of death compared with EA. Among older patients, we observed a modest increase in risk of death among AA men compared with EA [HR 1.16 (95 % CI 1.01–1.32)] but no difference by race between women [HR 0.94 (95 % CI 0.82–1.08)]. Moreover, we observed that the disparity in survival has worsened over the past 15 years.

Conclusions

Future studies that integrate clinical, molecular, and treatment-related data are needed for advancing understanding of the racial disparity in CRC survival, especially for those <50 years old.

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Acknowledgments

Funding for this research was from an American Cancer Society Institutional Research Grant awarded to the Hollings Cancer Center, Medical University of South Carolina (IRG-97-219-11); the National Cancer Institute via the Hollings Cancer Center NCI Cancer Center Support Grant (P30 CA138313); the Centers for Disease Control and Prevention cooperative agreement to the SC Dept of Health & Environmental Control, Central Cancer Registry (DP12-1205); and a K07 Career Development Award to Dr. Wallace (K07CA151864-01A1).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Epidemiology and Biostatistics, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA

    Kristin Wallace, Elizabeth G. Hill, Grace Williamson, Stephanie Oppenheimer, Marvella E. Ford & Anthony J. Alberg

  2. Department of Pathology, Medical University of South Carolina, Charleston, SC, USA

    David N. Lewin

  3. Department of Pharmacology, Medical University of South Carolina, Charleston, SC, USA

    Michael J. Wargovich

  4. Department of Biological Sciences, Center for Colon Cancer Research, University of South Carolina, Columbia, SC, USA

    Franklin G. Berger

  5. South Carolina Central Cancer Registry, Columbia, SC, USA

    Susan W. Bolick

  6. Division of Medical Oncology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA

    Melanie B. Thomas

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  1. Kristin Wallace
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  2. Elizabeth G. Hill
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Correspondence to Kristin Wallace.

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Wallace, K., Hill, E.G., Lewin, D.N. et al. Racial disparities in advanced-stage colorectal cancer survival. Cancer Causes Control 24, 463–471 (2013). https://doi.org/10.1007/s10552-012-0133-5

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  • DOI: https://doi.org/10.1007/s10552-012-0133-5

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