title: Racial-ethnic colorectal cancer survival disparities in the mountain west region: the case of Blacks compared to Whites.
abstract: BACKGROUND
  Substantial disparities in colorectal cancer (CRC) survival among racial-ethnic groups, especially between Blacks and Whites, have been extensively documented in the Northeast, California and South of the United States. The purpose of this study was to ascertain the determinants of colorectal cancer racial-ethnic survival disparities in a state of the Mountain West region, Nevada.
  
  
  METHODS
  The study population consisted of a cohort of 12,181 men and women with a first primary invasive carcinoma in the colon and rectum diagnosed between 1995 and 2007, identified through the Nevada Central Cancer Registry and followed for vital status until 31 December 2007. Likelihood ratio chi-square statistics were used to compare the sociodemographic and clinical characteristics for race-ethnicity. Cox proportional regression modeling and partial likelihood tests were used to estimate the hazard ratios and assess interaction effects in CRC cause-specific death.
  
  
  RESULTS
  Blacks and Hispanics were more likely to be diagnosed with distant stage disease, 22.4% and 21.5% respectively, compared to 17.9% in Whites. No difference was observed between racial-ethnic groups for diagnoses in regional stage. Univariate analysis yielded a 20.1% higher risk of CRC death for Blacks compared to Whites [95% CI = 1.05-1.37]. Adjustment for tumor stage, sex, age, diagnosis period, tumor sublocation, marital status, and economic status in the multivariate model showed a persistently increased risk of CRC death for Blacks (HR = 1.17, 95% CI = 1.02-1.33) in relation to Whites.
  
  
  CONCLUSIONS
  Survival disparities persisted among Blacks in our study even after adjusting for common demographic and tumor factors. Further determinants of survival disparities between race/ethnicities, such as course of treatment, should be investigated. Additionally, more public health intervention programs should tailor CRC screening awareness towards minorities as well as ensuring equal access to health care and quality treatment.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Community Health Sciences, University of Nevada Las Vegas 89154, USA. wassiral@unlv.nevada.edu
authors.forename: Lucas N
authors.initials: LN
authors.lastname: Wassira
authors.forename: Paulo S
authors.initials: PS
authors.lastname: Pinheiro
authors.forename: James
authors.initials: J
authors.lastname: Symanowski
authors.forename: Alicia
authors.initials: A
authors.lastname: Hansen
mesh_terms: D016009:Chi-Square Distribution; D003110:Colonic Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D009505:Nevada / Q000453:epidemiology; D012004:Rectal Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D016019:Survival Analysis