Inter-country and ethnic variation in colorectal cancer survival: comparisons between a Philippine population, Filipino-Americans and Caucasians.
BACKGROUND
Previous population-based studies showed differences in international and within country colorectal cancer survival estimates, but few investigated the role of prognostic factors. Using a "high resolution approach", we aimed to determine the effect of ethnicity and health care by comparing Filipino-Americans with Philippine residents, who have the same ethnicity, and with Caucasians living in the US, who have the same health care system.


METHODS
Using databases from the Manila and Rizal Cancer Registries and the United States Surveillance, Epidemiology and End Results, age-adjusted five-year absolute and relative survival estimates were computed and compared between Filipino-American colorectal cancer patients, cancer patients from the Philippines and Caucasian patients. Cox proportional hazards modelling was used to determine factors affecting survival differences.


RESULTS
Much lower 5-year relative survival estimates were obtained for Philippine residents (37%) as compared to those in Filipino-Americans (60.3%) and Caucasians (62.4%). Differences in age, stage and receipt of surgery explained a large proportion of the survival differences between Philippine residents and Filipino-Americans. However, strong excess risk of death for Philippine residents remained after controlling for these and other variables (relative risk, RR, 2.03, 95% confidence interval, 95% CI, 1.83-2.25).


CONCLUSIONS
Strong survival disadvantages of Philippine residents compared to Filipino-American patients were disclosed, which most likely reflect differences in access to and utilization of health care. Health education and advocacy, for both patients and health practitioners, should likewise be given priority.
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
Maria Theresa
MT
Redaniel
Adriano
A
Laudico
Maria Rica
MR
Mirasol-Lumague
Adam
A
Gondos
Gemma
G
Uy
Hermann
H
Brenner
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010679:Philippines / Q000453:epidemiology / Q000208:ethnology; D018426:SEER Program; D012737:Sex Factors; D012959:Socioeconomic Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D044465:White People