Saturday, July 13, 2024

Disparities in Colorectal Cancer Survival Among Non-Hispanic Black Americans

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In a recent study, researchers delved into the stark disparities in colorectal cancer (CRC) survival rates between non-Hispanic Black (NHB) and non-Hispanic white (NHW) Americans. Utilizing data from two extensive nationwide cohorts, the Surveillance, Epidemiology, and End Results (SEER) registry and the United States Veterans Health Administration (VA), the study aimed to discern the roles of biological factors and access to healthcare in these racial disparities.

Data and Methods

The study examined adults diagnosed with CRC between 2010 and 2020 who identified as NHB or NHW. In the SEER database, 263,893 patients were identified, with 14% being NHB. From the VA, data on 24,375 patients were analyzed, of which 20% were NHB. Researchers performed stratified survival analyses focusing on overall survival (OS) with cancer-specific survival used in sensitivity analyses.

Key Findings

Significant disparities in OS were observed in the SEER registry, with NHB patients showing a median OS of 57 months compared to 72 months for NHW patients. The hazard ratio (HR) for NHB patients was 1.14, indicating a higher risk of mortality. However, in the VA cohort, the disparity was notably less pronounced, with a median OS of 65 months for NHB patients versus 69 months for NHW patients, and an HR of 1.02.

The study highlighted a critical interaction between race and Medicare age eligibility in the SEER registry. NHB patients under 65 years old had a HR of 1.44, showing a more significant disadvantage compared to those over 65 years old (HR 1.13). This interaction was not evident in the VA data, suggesting that access to care could mitigate racial disparities in CRC outcomes.

Market Access Insights

The findings underscore the importance of equitable healthcare access in addressing racial disparities in CRC survival:

  • Enhanced healthcare access might reduce survival disparities among younger NHB patients.
  • Medicare’s role appears crucial in leveling the playing field for older patients.
  • Healthcare systems like the VA, which provide more uniform access, show less disparity in outcomes.

These insights emphasize the need for policy interventions aimed at improving healthcare access to mitigate racial disparities in CRC survival rates.

The study’s results indicate that while biological factors play a role, access to healthcare is a significant determinant of survival disparities in colorectal cancer among NHB and NHW populations. The attenuated disparities in the VA cohort suggest that improving healthcare access can potentially bridge the survival gap, particularly in younger populations who might not yet qualify for Medicare.

Original Article:

Front Public Health. 2024 Jun 19;12:1414361. doi: 10.3389/fpubh.2024.1414361. eCollection 2024.

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ABSTRACT

INTRODUCTION: Non-Hispanic Black (NHB) Americans have a higher incidence of colorectal cancer (CRC) and worse survival than non-Hispanic white (NHW) Americans, but the relative contributions of biological versus access to care remain poorly characterized. This study used two nationwide cohorts in different healthcare contexts to study health system effects on this disparity.

METHODS: We used data from the Surveillance, Epidemiology, and End Results (SEER) registry as well as the United States Veterans Health Administration (VA) to identify adults diagnosed with colorectal cancer between 2010 and 2020 who identified as non-Hispanic Black (NHB) or non-Hispanic white (NHW). Stratified survival analyses were performed using a primary endpoint of overall survival, and sensitivity analyses were performed using cancer-specific survival.

RESULTS: We identified 263,893 CRC patients in the SEER registry (36,662 (14%) NHB; 226,271 (86%) NHW) and 24,375 VA patients (4,860 (20%) NHB; 19,515 (80%) NHW). In the SEER registry, NHB patients had worse OS than NHW patients: median OS of 57 months (95% confidence interval (CI) 55-58) versus 72 months (95% CI 71-73) (hazard ratio (HR) 1.14, 95% CI 1.12-1.15, p = 0.001). In contrast, VA NHB median OS was 65 months (95% CI 62-69) versus NHW 69 months (95% CI 97-71) (HR 1.02, 95% CI 0.98-1.07, p = 0.375). There was significant interaction in the SEER registry between race and Medicare age eligibility (p < 0.001); NHB race had more effect in patients <65 years old (HR 1.44, 95% CI 1.39-1.49, p < 0.001) than in those ≥65 (HR 1.13, 95% CI 1.11-1.15, p < 0.001). In the VA, age stratification was not significant (p = 0.21).

DISCUSSION: Racial disparities in CRC survival in the general US population are significantly attenuated in Medicare-aged patients. This pattern is not present in the VA, suggesting that access to care may be an important component of racial disparities in this disease.

PMID:38962767 | PMC:PMC11220245 | DOI:10.3389/fpubh.2024.1414361

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