title: An interaction of race and ethnicity with socioeconomic status in rectal cancer outcomes.
abstract: OBJECTIVE
  Because appropriate rectal cancer care and subsequent outcomes can be influenced by several variables, our objective was to investigate how race, ethnicity, and socioeconomic status (SES) may impact rectal cancer outcomes.
  
  
  BACKGROUND
  The management of rectal cancer requires a multidisciplinary approach utilizing medical and surgical subspecialties.
  
  
  METHODS
  We performed an investigation of patients with rectal adenocarcinoma from Los Angeles County from 1988 to 2006 using the Los Angeles County Cancer Surveillance Program. Clinical and pathologic characteristics were compared among groups and overall survival was stratified by race/ethnicity and SES.
  
  
  RESULTS
  Of 9504 patients with rectal cancer, 53% (n = 4999) were white, 10% black, 18% Hispanic, and 14% Asian. Stratified by race/ethnicity, Asians had the best overall survival followed by Hispanics, whites, and blacks (median survival 7.7 vs. 5.7, 5.5, and 3.4 years, respectively; P < 0.001). Stratified by SES group, the highest group had the best overall survival followed by middle and lowest groups (median survival 8.4 vs. 5.1 and 3.8 years, respectively, P < 0.001). Similar results were observed for surgical patients. On multivariate analysis, race/ethnicity, and SES remained independent predictors of overall survival in patients with rectal adenocarcinoma. Furthermore, interaction analysis indicated that the improved survival for select racial/ethnic groups was not dependent on SES classification.
  
  
  CONCLUSIONS
  Within the diverse Los Angeles County population, both race/ethnicity, and SES result in inequities in rectal cancer outcomes. Although SES may directly impact outcomes via access to care, the reasons for the association between race/ethnicity and outcomes remain uncertain.
authors.affiliation: Division of Oncologic Surgery, Department of Surgery, City of Hope, Duarte, CA 91010, USA. jokim@coh.org
authors.forename: Joseph
authors.initials: J
authors.lastname: Kim
authors.forename: Avo
authors.initials: A
authors.lastname: Artinyan
authors.forename: Brian
authors.initials: B
authors.lastname: Mailey
authors.forename: Stefanie
authors.initials: S
authors.lastname: Christopher
authors.forename: Wendy
authors.initials: W
authors.lastname: Lee
authors.forename: Shaun
authors.initials: S
authors.lastname: McKenzie
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chen
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
authors.forename: Alessio
authors.initials: A
authors.lastname: Pigazzi
authors.forename: Julio
authors.initials: J
authors.lastname: Garcia-Aguilar
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality* / Q000601:surgery; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000704:Analysis of Variance; D002140:California; D003113:Colonoscopy / Q000706:statistics & numerical data; D016001:Confidence Intervals; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D020380:Needs Assessment; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality* / Q000601:surgery; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012959:Socioeconomic Factors; D016019:Survival Analysis; D044465:White People / Q000706:statistics & numerical data