The relationship between ethnicity, social deprivation and late presentation of colorectal cancer.
Tumour staging at time of presentation is an important factor in determining survival in colorectal cancer. The aim of this paper is to investigate the relationship between ethnicity and deprivation in late (Stage IV) presentation of colorectal cancer.



Data from the Thames Cancer Registry comprising 77,057 colorectal cancer patients between the years 2000 and 2012 were analysed.



A total of 17,348 patients were identified with complete data, of which 53.9% were male. Patients from a Black Afro/Caribbean background were diagnosed with CRC at a much younger age than the White British group (median age 67 compared with 72, p<0.001). In multiple regression, ethnicity, deprivation and age were positive predictors of presenting with advanced tumour stage at time of diagnosis. Black patients were more likely to present with Stage IV tumours than white patients (OR 1.37, 95% CI 1.18-1.59, p<0.001). Social deprivation was also a predictor of Stage IV cancer presentation, with the most deprived group (Quintile 5) 1.26 times more likely to be diagnosed with Stage IV cancer compared with the most affluent group (CI 1.13-1.40, p<0.001). Sub-group analyses demonstrated that Black & Affluent patients were still at greater risk of Stage IV CRC than their White & Affluent counterparts (OR 1.24, 95% CI 1.11-1.45, p=0.023). Patients with rectal cancer were less likely to present with Stage IV CRC (OR 0.66, 95% CI 0.61-0.71, p<0.001).



Racial and age related disparities exist in tumour presentation in the United Kingdom. Patients from black and socially deprived backgrounds as well as the elderly are more likely to present with advanced tumours at time of diagnosis.
Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital & Academic Institute, Harrow, Middlesex, HA1 3UJ, United Kingdom. Electronic address: alan.askari@gmail.com.
Alan
A
Askari
Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital & Academic Institute, Harrow, Middlesex, HA1 3UJ, United Kingdom. Electronic address: subra.nachiappan.doctor@gmail.com.
Subramanian
S
Nachiappan
Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital & Academic Institute, Harrow, Middlesex, HA1 3UJ, United Kingdom.
Andrew
A
Currie
Department of Gastroenterology, St Mark's Hospital, Harrow, Middlesex, HA1 3UJ, United Kingdom; Imperial College London, United Kingdom. Electronic address: andrew.latchford@nhs.net.
Andrew
A
Latchford
Department of Surgery and Cancer, Imperial College, United Kingdom. Electronic address: justinstebbing@gmail.com.
Justin
J
Stebbing
Faculty of Medicine, School of Public Health, Dr Foster Unit, Imperial College London, United Kingdom. Electronic address: robert.bottle@imperial.ac.uk.
Alex
A
Bottle
Department of Surgery and Cancer, Imperial College, United Kingdom. Electronic address: t.athanasiou@imperial.ac.uk.
Thanos
T
Athanasiou
Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital & Academic Institute, Harrow, Middlesex, HA1 3UJ, United Kingdom; Department of Surgery and Cancer, Imperial College, United Kingdom. Electronic address: omarfaiz@aol.com.
Omar
O
Faiz
D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000523:psychology*; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012042:Registries; D012934:Social Isolation / Q000523:psychology*; D012959:Socioeconomic Factors; D006113:United Kingdom
Age; Colorectal cancer; Ethnicity; Social deprivation