Meta-analysis of racial disparities in survival in association with socioeconomic status among men and women with colon cancer.
BACKGROUND
Few studies have addressed racial disparities in survival for colon cancer by adequately incorporating both treatment and socioeconomic factors, and the findings from those studies have been inconsistent. The objectives of the current study were to systematically review the existing literature and provide a more stable estimate of the measures of association between socioeconomic status and racial disparities in survival for colon cancer by undertaking a meta-analysis.


METHODS
For this meta-analysis, the authors searched the MEDLINE database to identify articles published in English from 1966 to August 2006 that met the following inclusion criteria: original research articles that addressed the association between race/ethnicity and survival in patients with colon or colorectal cancer after adjusting for socioeconomic status. In total, 66 full articles were reviewed, and 56 of those articles were excluded, which left 10 studies for the final analysis.


RESULTS
The pooled hazard ratio (HR) for African Americans compared with Caucasians was 1.14 (95% confidence interval [95% CI], 1.00-1.29) for all-cause mortality and 1.13 (95% CI, 1.01-1.28) for colon cancer-specific mortality. The test for homogeneity of the HR was statistically significant across the studies for all-cause mortality (Q=31.69; P<.001) but was not significant across the studies for colon cancer-specific mortality (Q=7.45; P=.114).


CONCLUSIONS
Racial disparities in survival for colon cancer between African Americans and Caucasians were only marginally significant after adjusting for socioeconomic factors and treatment. Attempts to modify treatment and socioeconomic factors with the objective of reducing racial disparities in health outcomes may have important clinical and public health implications.
Du
Xianglin L
XL
Division of Epidemiology, School of Public Health, University of Texas Health Science Center, Houston, Texas 77030, USA. xianglin.l.du@uth.tmc.edu
Meyer
Tamra E
TE
Franzini
Luisa
L
D001741:Black or African American / Q000706:statistics & numerical data*; D003110:Colonic Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D012307:Risk Factors; D018426:SEER Program; D012923:Social Class; D012959:Socioeconomic Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*