title: Racial differences in colorectal cancer incidence and mortality in the Women's Health Initiative.
abstract: BACKGROUND
  Colorectal cancer (CRC) incidence and mortality rates are higher in African-Americans as compared with other racial/ethnic groups. The women's health initiative (WHI) study sample was used to determine whether differences in CRC risk factors explain racial/ethnic differences in incidence and mortality.
  
  
  METHODS
  The WHI is a longitudinal study of postmenopausal women recruited from 40 centers. Baseline questionnaires were used to collect sociodemographic and health status information. All CRC diagnoses were centrally adjudicated. Cox regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for invasive CRC by race/ethnicity.
  
  
  RESULTS
  The study sample included 131,481 (83.7%) White, 14,323 (9.1%) African-American, 6,362 (4.1%) Hispanic, 694 (0.4%) Native American and 4,148 (2.6%) Asian/Pacific Islanders. After a mean follow-up of 10.8 years (SD 2.9), CRC incidence was the highest in African-Americans (annualized rate = 0.14%), followed by Whites and Native Americans (0.12% each), Asian/Pacific Islanders (0.10%), and Hispanics (0.08%). After adjustment for age and trial assignment, Hispanics had a lower risk compared with Whites, HR 0.73 (95% CI: 0.54-0.97) (P = 0.03), and African-Americans had a marginally greater risk, HR 1.16 (95% CI: 0.99-1.34), P = 0.06. Multivariable adjustment attenuated the difference in incidence between African-Americans and Whites (HR 0.99, 95% CI: 0.82-1.20), while strengthening the lower HR for Hispanics (HR 0.68, 95% CI: 0.48-0.97).
  
  
  CONCLUSIONS
  African-American/White differences in CRC risk are likely due to sociodemographic/cultural factors other than race.
  
  
  CONCLUSIONS
  A number of modifiable exposures could be a focus for reducing CRC risk in African-Americans.
authors: Karmanos Cancer Institute, Department of Oncology, Detroit, MI, USA. simonm@karmanos.org
authors: Michael S
authors: MS
authors: Simon
authors: Cynthia A
authors: CA
authors: Thomson
authors: Erin
authors: E
authors: Pettijohn
authors: Ikuko
authors: I
authors: Kato
authors: Rebecca J
authors: RJ
authors: Rodabough
authors: Dorothy
authors: D
authors: Lane
authors: F Allan
authors: FA
authors: Hubbell
authors: Mary Jo
authors: MJ
authors: O'Sullivan
authors: Lucille
authors: L
authors: Adams-Campbell
authors: Charles P
authors: CP
authors: Mouton
authors: Judith
authors: J
authors: Abrams
authors: Rowan T
authors: RT
authors: Chlebowski
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