Socioeconomic and demographic disparities in treatment for carcinomas of the colon and rectum.
BACKGROUND
The current study examined the relationship between socioeconomic and demographic factors and type of treatment for carcinomas of the colon and rectum. The National Institutes of Health and the National Cancer Institute recommend surgery followed by adjuvant chemo- and/or radiotherapy for Stage III colon and Stages II and III rectal carcinomas.


METHODS
The authors linked Washington State's cancer registry and hospital discharge records and U.S. census data to assess socioeconomic and demographic factors related to treatment, controlling for clinical factors.


RESULTS
Compared to colon carcinoma patients under age 65 years, patients aged 75-84 years and 85 years or older were at higher risk for a treatment plan of surgery without adjuvant therapy (adjusted odds ratio [OR] = 2.5, 95% confidence interval [CI] = 1.3-4.7; OR = 14.1, CI = 6.3-31.4, respectively). Risk of no adjuvant therapy was more than doubled for patients in zip codes in the lowest quartile of per capita income compared to the top three quartiles (OR = 2.3, CI = 1.5-3.4) and for those with Medicare compared to private insurance (OR = 2.2, CI = 1.3-3.8). Older patients with rectal carcinoma were also at higher risk of a treatment plan that did not include adjuvant therapy.


CONCLUSIONS
The current findings suggest disparities in the provision of recommended medical procedures related to socioeconomic and demographic factors.
Washington State Department of Health, Olympia, Washington 98504, USA. juliet.vaneenwyk@doh.wa.gov
Juliet
J
VanEenwyk
Joseph S
JS
Campo
Eric M
EM
Ossiander
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000628:therapy*; D012959:Socioeconomic Factors