title: Race, treatment, and survival among colorectal carcinoma patients in an equal-access medical system.
abstract: BACKGROUND
  The aim of this study was to assess the influence of race on the treatment and survival of patients with colorectal carcinoma.
  
  
  METHODS
  This retrospective cohort study included all white or black male veterans given a new diagnosis of colorectal carcinoma in 1989 at Veterans Affairs Medical Centers nationwide. After adjusting for patient demographics, comorbidity, distant metastases, and tumor location, the authors determined the likelihood of surgical resection, chemotherapy, radiation therapy, and death in each case.
  
  
  RESULTS
  Of the 3176 veterans identified, 569 (17.9%) were black. Bivariate analyses and logistic regression revealed no significant differences in the proportions of patients undergoing surgical resection (70% vs. 73%, odds ratio 0.92, 95% confidence interval 0.74-1.15), chemotherapy (23% vs. 23%, odds ratio 0.99, 95% confidence interval 0.78-1.24), or radiation therapy (17% vs. 16%, odds ratio 1.10, 95% confidence interval 0.85-1.43) for black versus white patients. Five-year relative survival rates were similar for black and white patients (42% vs. 39%, respectively; P=0.16), though the adjusted mortality risk ratio was modestly increased (risk ratio 1.13, 95% confidence interval 1.01-1.28).
  
  
  CONCLUSIONS
  Overall, race was not associated with the use of surgery, chemotherapy, or radiation therapy in the treatment of colorectal carcinoma among veterans seeking health care at Veterans Affairs Medical Centers. Although mortality from all causes was higher among black veterans with colorectal carcinoma, this finding may be attributed to underlying racial differences associated with survival. This study suggests that when there is equal access to care, there are no differences with regard to race.
authors.affiliation: Center for Health Services Research and Development, Veterans Affairs Medical Center, Durham, North Carolina, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Dominitz
authors.forename: G P
authors.initials: GP
authors.lastname: Samsa
authors.forename: P
authors.initials: P
authors.lastname: Landsman
authors.forename: D
authors.initials: D
authors.lastname: Provenzale
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D002277:Carcinoma / Q000208:ethnology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States; D014728:Veterans; D044465:White People / Q000706:statistics & numerical data