Exploring the complexity and spectrum of racial/ethnic disparities in colon cancer management

• Published in: International journal for equity in health Vol. 22; no. 1; p. 68
• Main Authors: Greenberg, Anya L, Brand, Nathan R, Zambeli-Ljepović, Alan, Barnes, Katherine E, Chiou, Sy Han, Rhoads, Kim F, Adam, Mohamed A, Sarin, Ankit
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 14.04.2023; BioMed Central; BMC
• Subjects: American Indian or Alaska Native - statistics & numerical data; Analysis; Asian - statistics & numerical data; Black or African American - statistics & numerical data; Cancer; Cancer therapies; Care and treatment; Chemotherapy; Colon; Colon cancer; Colonic Neoplasms - epidemiology; Colonic Neoplasms - ethnology; Colonic Neoplasms - mortality; Colonic Neoplasms - therapy; Colorectal cancer; Colorectal carcinoma; Colorectal surgery; Cultural differences; Databases, Factual - statistics & numerical data; Death; Demographic aspects; Demographics; Diagnosis; Domains; East Asian People - statistics & numerical data; Economic aspects; Ethnicity; Ethnicity - statistics & numerical data; Family income; Female; Health aspects; Health care disparities; Health Services Accessibility - statistics & numerical data; Healthcare access; Healthcare Disparities - ethnology; Healthcare Disparities - standards; Healthcare Disparities - statistics & numerical data; Hispanic or Latino - statistics & numerical data; Hispanic people; Humans; Laparoscopy; Male; Minority & ethnic groups; Morbidity; Mortality; Native Hawaiian or Other Pacific Islander - statistics & numerical data; Oncology, Experimental; Pacific Islander people; Patient outcomes; Patients; Race; Race Factors - statistics & numerical data; Racial disparities; Racial Groups - statistics & numerical data; Robotic surgery; Secondary schools; Social aspects; South Asian People - statistics & numerical data; Southeast Asian People - statistics & numerical data; Statistical analysis; Surgery; Treatment Outcome; United States - epidemiology; Variables; United States; Spain; United States > US; Healthcare access; Colon cancer; Racial disparities; Colorectal surgery
• ISSN: 1475-9276; 1475-9276
• DOI: 10.1186/s12939-023-01883-w

Colorectal cancer is a leading cause of morbidity and mortality across U.S. racial/ethnic groups. Existing studies often focus on a particular race/ethnicity or single domain within the care continuum. Granular exploration of disparities among different racial/ethnic groups across the entire colon cancer care continuum is needed. We aimed to characterize differences in colon cancer outcomes by race/ethnicity across each stage of the care continuum. We used the 2010-2017 National Cancer Database to examine differences in outcomes by race/ethnicity across six domains: clinical stage at presentation; timing of surgery; access to minimally invasive surgery; post-operative outcomes; utilization of chemotherapy; and cumulative incidence of death. Analysis was via multivariable logistic or median regression, with select demographics, hospital factors, and treatment details as covariates. 326,003 patients (49.6% female, 24.0% non-White, including 12.7% Black, 6.1% Hispanic/Spanish, 1.3% East Asian, 0.9% Southeast Asian, 0.4% South Asian, 0.3% AIAE, and 0.2% NHOPI) met inclusion criteria. Relative to non-Hispanic White patients: Southeast Asian (OR 1.39, p < 0.01), Hispanic/Spanish (OR 1.11 p < 0.01), and Black (OR 1.09, p < 0.01) patients had increased odds of presenting with advanced clinical stage. Southeast Asian (OR 1.37, p < 0.01), East Asian (OR 1.27, p = 0.05), Hispanic/Spanish (OR 1.05 p = 0.02), and Black (OR 1.05, p < 0.01) patients had increased odds of advanced pathologic stage. Black patients had increased odds of experiencing a surgical delay (OR 1.33, p < 0.01); receiving non-robotic surgery (OR 1.12, p < 0.01); having post-surgical complications (OR 1.29, p < 0.01); initiating chemotherapy more than 90 days post-surgery (OR 1.24, p < 0.01); and omitting chemotherapy altogether (OR 1.12, p = 0.05). Black patients had significantly higher cumulative incidence of death at every pathologic stage relative to non-Hispanic White patients when adjusting for non-modifiable patient factors (p < 0.05, all stages), but these differences were no longer statistically significant when also adjusting for modifiable factors such as insurance status and income. Non-White patients disproportionately experience advanced stage at presentation. Disparities for Black patients are seen across the entire colon cancer care continuum. Targeted interventions may be appropriate for some groups; however, major system-level transformation is needed to address disparities experienced by Black patients.