title: Racial differences in tumor stage and survival for colorectal cancer in an insured population.
abstract: BACKGROUND
  Despite declining death rates from colorectal cancer (CRC), racial disparities have continued to increase. In this study, the authors examined disparities in a racially diverse group of insured patients.
  
  
  METHODS
  This study was conducted among patients who were diagnosed with CRC from 1993 to 1998, when they were enrolled in integrated healthcare systems. Patients were identified from tumor registries and were linked to information in administrative databases. The sample was restricted to non-Hispanic whites (n = 10,585), non-Hispanic blacks (n = 1479), Hispanics (n = 985), and Asians/Pacific Islanders (n = 909). Differences in tumor stage and survival were analyzed by using polytomous and Cox regression models, respectively.
  
  
  RESULTS
  In multivariable regression analyses, blacks were more likely than whites to have distant or unstaged tumors. In Cox models that were adjusted for nonmutable factors, blacks had a higher risk of death from CRC (hazard ratio [HR], 1.17; 95% confidence interval [95% CI], 1.06-1.30). Hispanics had a risk of death similar to whites (HR, 1.04; 95% CI, 0.92-1.18), whereas Asians/Pacific Islanders had a lower risk of death from CRC (HR, 0.89; 95% CI, 0.78-1.02). Adjustment for tumor stage decreased the HR to 1.11 for blacks, and the addition of receipt of surgical therapy to the model decreased the HR further to 1.06. The HR among Hispanics and Asians/Pacific Islanders was stable to adjustment for tumor stage and surgical therapy.
  
  
  CONCLUSIONS
  The relation between race and survival from CRC was complex and appeared to be related to differences in tumor stage and therapy received, even in insured populations. Targeted interventions to improve the use of effective screening and treatment among vulnerable populations may be needed to eliminate disparities in CRC.
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA. chyke.doubeni@umassmed.edu
authors.forename: Chyke A
authors.initials: CA
authors.lastname: Doubeni
authors.forename: Terry S
authors.initials: TS
authors.lastname: Field
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.forename: Eli J
authors.initials: EJ
authors.lastname: Korner
authors.forename: Carol
authors.initials: C
authors.lastname: Bigelow
authors.forename: Lois
authors.initials: L
authors.lastname: Lamerato
authors.forename: Lisa
authors.initials: L
authors.lastname: Herrinton
authors.forename: Virginia P
authors.initials: VP
authors.lastname: Quinn
authors.forename: Gene
authors.initials: G
authors.lastname: Hart
authors.forename: Mark C
authors.initials: MC
authors.lastname: Hornbrook
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.forename: Edward H
authors.initials: EH
authors.lastname: Wagner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data*; D044383:Black People / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D005006:Ethnicity; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D044465:White People / Q000706:statistics & numerical data*