title: Racial differences in the outcome of patients with colorectal carcinoma.
abstract: BACKGROUND
  African-American (AA) patients with colorectal carcinoma have a worse prognosis compared with Caucasians. To analyze the causes of this disparity in survival, a retrospective study of patients with colorectal carcinoma was undertaken. The impact of treatments received and the role of socioeconomic factors such as income, education, and poverty levels were studied.
  
  
  METHODS
  A retrospective analysis of patients with colorectal carcinoma at a single institution was conducted. The overall survival of AA and Caucasians, stage at presentation, treatment received, and socioeconomic factors were analyzed using the institutional tumor registry and 1990 census data.
  
  
  RESULTS
  The overall survival of AA patients was worse compared with Caucasians, both due to all causes (P < 0.001) and cancer-related deaths (P < 0.001). The relative risk of death due to all causes was 1.4 (95% confidence interval [CI] 1.2-1.8) for AA, 4.3 for patients with Stage IV disease (95% CI 3.2-5.7), and 2.3 for patients not undergoing surgery (95% CI 1.7-3.1). After multivariate adjustment for gender, site, socioeconomic factors, and therapeutic modalities, the relative risks for death were 1.5 (95% CI 1.2) for AA, 1.4 (95% CI 1.1-1.7) for patients 60 years of age or older, and 4.2 (95% CI 3.4-5.2) for Stage IV disease. The survival difference between AA and Caucasians was not influenced by income, poverty level, and education. African Americans were treated less frequently with chemotherapy and radiation therapy compared with their Caucasian counterparts.
  
  
  CONCLUSIONS
  African American patients with colorectal carcinoma have a poorer prognosis compared with Caucasians. This discrepancy may be due to decreased utilization of chemotherapy and radiation therapy. Socioeconomic factors and lack of access to health care do not entirely explain the worse prognosis of AA. These factors should be identified and dealt with to improve the health care of AA patients with various malignant disorders.
authors.affiliation: Division of Hematology/Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences and Arkansas Cancer Research Center, Little Rock, Arkansas 72205, USA. govindarajanrang@uam.edu
authors.forename: Rangaswamy
authors.initials: R
authors.lastname: Govindarajan
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Shah
authors.forename: Linda G
authors.initials: LG
authors.lastname: Erkman
authors.forename: Laura F
authors.initials: LF
authors.lastname: Hutchins
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001131:Arkansas; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data*