- •Disparities are pronounced in patients with colorectal cancer.
- •Rates of advanced colorectal cancer have increased between 2004 and 2015.
- •Access to colorectal cancer screening should be prioritized.
We aimed to identify differences in disparities among patients with a cancer in which screening is widely recommended (colorectal cancer [CRC]) and one in which it is not (esophageal cancer).
A retrospective analysis was performed using 2004–2015 data from the National Cancer Database. Multivariable generalized logistic regression was used to identify potential differences in the effect of disparities in stage at diagnosis.
A total of 96,524 esophageal cancer patients and 361,187 CRC patients were included. Black patients, longer travel distances, and lower educational attainment were only associated with increased odds of stage IV CRC. While both Medicaid and uninsured patients were more likely to be diagnosed with stage IV esophageal and CRC, the effect was larger among CRC patients. From 2004 to 2015, the rates of stage IV esophageal cancer decreased from 42.0% to 38.2%, while the rates of stage IV CRC increased from 36.9% to 40.8% (p < 0.0001).
Disparities are more pronounced in CRC, compared to esophageal cancer. Equity in access to screening and cancer care should be prioritized.
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- Cancer statistics, 2017.CA A Cancer J Clin. 2017; 67: 7-30
- Social determinants of health in the United States: addressing major health inequality trends for the nation, 1935-2016.Int J MCH AIDS. 2017; 6: 139-164
- Socioeconomic and racial/ethnic disparities in cancer mortality, incidence, and survival in the United States, 1950-2014: over six decades of changing patterns and widening inequalities.J Environ Public Health. 2017; 20172819372
- Vital signs: health insurance coverage and health care utilization --- United States, 2006--2009 and January-March 2010.MMWR Morb Mortal Wkly Rep. 2010; 59: 1448-1454
- Patients’ barriers to receipt of cancer care, and factors associated with needing more assistance from a patient navigator.J Natl Med Assoc. 2011; 103: 701-710
- Colorectal cancer statistics, 2017.CA Cancer J Clin. 2017; 67: 177-193
- Surveillance, epidemiology, and end results program. Cancer stat facts: esophageal cancer.(Available at:)https://seer.cancer.gov/statfacts/html/esoph.htmlDate accessed: May 4, 2018
- Trends in esophageal adenocarcinoma incidence and mortality.Cancer. 2013; 119: 1149-1158
- Predicting the future burden of esophageal cancer by histological subtype: international trends in incidence up to 2030.Am J Gastroenterol. 2017; 112: 1247-1255
- Surveillance, epidemiology, and end results program. Cancer stat facts: colorectal cancer.(Available at:)https://seer.cancer.gov/statfacts/html/colorect.htmlDate accessed: May 4, 2018
- Lack of reduction in racial disparities in cancer-specific mortality over a 20-year period.Cancer. 2014; 120: 1532-1539
- Racial-ethnic disparities in late-stage colorectal cancer among hispanics and non-hispanic whites of New Mexico.Hisp Health Care Int. 2017; 15: 180-188
- Racial disparities in clinical presentation and survival times among young-onset colorectal adenocarcinoma.Dig Dis Sci. 2017; 62: 2526-2531
- Racial and ethnic disparities in cancer survival: the contribution of tumor, sociodemographic, institutional, and neighborhood characteristics.J Clin Oncol. 2018; 36: 25-33
- Colorectal cancer disparity in African Americans: risk factors and carcinogenic mechanisms.Am J Pathol. 2018; 188: 291-303
- Race and trust in the health care system.Public Health Rep. 2003; 118: 358-365
- African Americans and their distrust of the health care system: healthcare for diverse populations.J Cult Divers. 2007; 14: 56-60
- The late-stage diagnosis of colorectal cancer: demographic and socioeconomic factors.Am J Public Health. 1996; 86: 1794-1797
- Impact of socioeconomic status on cancer incidence and stage at diagnosis: selected findings from the surveillance, epidemiology, and end results: national longitudinal mortality study.Cancer Causes Control. 2009; 20: 417-435
- Rural-urban disparities in stage of diagnosis among cancers with preventive opportunities.Am J Prev Med. 2018; 54: 688-698
- Rural vs urban residence affects risk-appropriate colorectal cancer screening.Clin Gastroenterol Hepatol. 2013; 11: 526-533
- Disparities in quality of cancer care: the role of health insurance and population demographics.Medicine (Baltim). 2017; 96e9125
- The influence of insurance type on stage at presentation, treatment, and survival between Asian American and non-Hispanic White lung cancer patients.Cancer Med. 2018; 7: 1612-1629
- Breast cancer stage variation and survival in association with insurance status and sociodemographic factors in US women 18 to 64 years old.Cancer. 2017; 123: 3125-3131
- The impact of health insurance on cancer care in disadvantaged communities.Cancer. 2017; 123: 1219-1227
- United States health care reform: progress to date and next steps.J Am Med Assoc. 2016; 316: 525-532
- Taking stock: Health insurance coverage under the ACA as of September 2014.Urban Institute, Washington, DC2014 (Available at:)http://hrms.urban.org/briefs/Health-Insurance-Coverage-under-the-ACA-as-of-September-2014.htmlDate accessed: July 4, 2018
- The state of cancer care in America, 2014: a report by the American Society of Clinical Oncology.J Oncol Pract. 2014; 10: 119-142
- Causes of socioeconomic disparities in colorectal cancer and intervention framework and strategies.Gastroenterology. 2019; (epub ahead of print)https://doi.org/10.1053/j.gastro.2019.10.029
- Alerts in electronic medical records to promote a colorectal cancer screening programme: a cluster randomised controlled trial in primary care.Br J Gen Pract. 2016; 66: 483-490
- Effects of a community-to-clinic navigation intervention on colorectal cancer screening among underserved people.Ann Behav Med. 2019; (epub ahead of print)https://doi.org/10.1093/abm/kaz049
Published online: December 23, 2019
Accepted: December 19, 2019
Received in revised form: December 16, 2019
Received: May 27, 2019
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