title: Racial disparities in advanced-stage colorectal cancer survival.
abstract: OBJECTIVE
  African-Americans (AA) have a higher incidence of and lower survival from colorectal cancer (CRC) compared with European Americans (EA). In the present study, statewide, population-based data from South Carolina Central Cancer Registry are used to investigate the relationship between race and age on advanced-stage CRC survival.
  
  
  METHODS
  The study population was comprised of 3,865 advanced pathologically documented colon and rectal adenocarcinoma cases diagnosed between 01 January 1996 and 31 December 2006: 2,673 (69 %) EA and 1,192 (31 %) AA. Kaplan-Meier methods were used to generate median survival time and corresponding 95 % confidence intervals (CI) by race, age, and gender. Factors associated with survival were evaluated by fitting Cox proportional hazards regression models to generate hazard ratios (HR) and 95 % CI.
  
  
  RESULTS
  We observed a significant interaction between race and age on CRC survival (p = 0.04). Among younger patients (<50 years), AA race was associated with a 1.34 times (95 % CI 1.06-1.71) higher risk of death compared with EA. Among older patients, we observed a modest increase in risk of death among AA men compared with EA [HR 1.16 (95 % CI 1.01-1.32)] but no difference by race between women [HR 0.94 (95 % CI 0.82-1.08)]. Moreover, we observed that the disparity in survival has worsened over the past 15 years.
  
  
  CONCLUSIONS
  Future studies that integrate clinical, molecular, and treatment-related data are needed for advancing understanding of the racial disparity in CRC survival, especially for those <50 years old.
authors.affiliation: Division of Epidemiology and Biostatistics, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. wallack@musc.edu
authors.forename: Kristin
authors.initials: K
authors.lastname: Wallace
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Hill
authors.forename: David N
authors.initials: DN
authors.lastname: Lewin
authors.forename: Grace
authors.initials: G
authors.lastname: Williamson
authors.forename: Stephanie
authors.initials: S
authors.lastname: Oppenheimer
authors.forename: Marvella E
authors.initials: ME
authors.lastname: Ford
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wargovich
authors.forename: Franklin G
authors.initials: FG
authors.lastname: Berger
authors.forename: Susan W
authors.initials: SW
authors.lastname: Bolick
authors.forename: Melanie B
authors.initials: MB
authors.lastname: Thomas
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Alberg
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D015179:Colorectal Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D013022:South Carolina / Q000453:epidemiology; D016019:Survival Analysis; D044465:White People / Q000706:statistics & numerical data*