title: Contribution of screening and survival differences to racial disparities in colorectal cancer rates.
abstract: BACKGROUND
  Considerable disparities exist in colorectal cancer (CRC) incidence and mortality rates between blacks and whites in the United States. We estimated how much of these disparities could be explained by differences in CRC screening and stage-specific relative CRC survival.
  
  
  METHODS
  We used the MISCAN-Colon microsimulation model to estimate CRC incidence and mortality rates in blacks, aged 50 years and older, from 1975 to 2007 assuming they had: (i) the same trends in screening rates as whites instead of observed screening rates (incidence and mortality); (ii) the same trends in stage-specific relative CRC survival rates as whites instead of observed (mortality only); and (iii) a combination of both. The racial disparities in CRC incidence and mortality rates attributable to differences in screening and/or stage-specific relative CRC survival were then calculated by comparing rates from these scenarios to the observed black rates.
  
  
  RESULTS
  Differences in screening accounted for 42% of disparity in CRC incidence and 19% of disparity in CRC mortality between blacks and whites. Thirty-six percent of the disparity in CRC mortality could be attributed to differences in stage-specific relative CRC survival. Together screening and survival explained a little more than 50% of the disparity in CRC mortality between blacks and whites.
  
  
  CONCLUSIONS
  Differences in screening and relative CRC survival are responsible for a considerable proportion of the observed disparities in CRC incidence and mortality rates between blacks and whites.
  
  
  CONCLUSIONS
  Enabling blacks to achieve equal access to care as whites could substantially reduce the racial disparities in CRC burden.
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. i.vogelaar@erasmusmc.nl
authors.forename: Iris
authors.initials: I
authors.lastname: Lansdorp-Vogelaar
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kuntz
authors.forename: Amy B
authors.initials: AB
authors.lastname: Knudsen
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Ballegooijen
authors.forename: Ann G
authors.initials: AG
authors.lastname: Zauber
authors.forename: Ahmedin
authors.initials: A
authors.lastname: Jemal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000208:ethnology* / Q000401:mortality; D055088:Early Detection of Cancer; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008403:Mass Screening; D008875:Middle Aged; D015996:Survival Rate; D044465:White People / Q000706:statistics & numerical data*