O. A. Akinyemi1, T. A. Weldeslase1, K. Elleissy Nasef1, G. A. Findlay1, E. Cornwell1, C. E. Nembhard1 1Howard University College Of Medicine, Washington, DC, USA
Introduction: Colorectal cancer remains the second killer among cancer deaths in America, with about 149,000 new cases diagnosed in 2021. Nearly 4% of men and women will be diagnosed with colorectal cancer in their lifetime. Social determinants of health continue to play an important role in the incidences, diagnosis, and survival among patients with colorectal cancers in the United States. The present study aims to determine the interaction between patients' race/ethnicity and median household income and how this influences survival among patients with colorectal cancers in the United States.
Methods: We utilized the Surveillance, Epidemiology, and End Results (SEER) 18 Registry to conduct a retrospective analysis of patients with a primary diagnosis of colorectal carcinoma. Patients were followed from 2007 to 2019. The primary outcome of interest was the overall survival. In addition, we utilized the cox regression model to determine the interaction between race/ethnicity and median household income and how this influences survival. Finally, we included the patient's age, sex, disease stage at presentation, and treatment modalities in the final analysis.
Results: There were 122 739 patients with a primary diagnosis of colorectal cancer in the SEER database between 2007-2019. 69.5% of these patients were Non-Hispanic White (NHW), 11.7% were Non-Hispanic Asian or Pacific Islanders (NHAPI), and 8.9% were Non-Hispanic Blacks (NHB), 8.3% were Hispanics, while about 1.5% belong to another race. The average five-year survival was 72.3% and when stratified by race/ethnicity (Whites, 72.6%, Blacks, 67.7%, Hispanics, 70.6%, Asians or Pacific Islanders, 74.6%, p < 0.001). There was a significant association between race and income in the overall survival, with the black race associated with the lowest survival. With increasing income, there was a corresponding improvement in survival across the different races/ethnicities. Black and Hispanic patients earning < $45,000 had a worse outcome than the reference group (Whites earning < $45,000). Only when Blacks earn above $55,000 do they have a similar survival compared to the reference. Hispanics and Asians or Pacific Islanders in the highest income group ($75,000+) have better survival than the reference group.
Conclusion: The study highlights significant racial and socioeconomic disparities in survival among patients with colorectal cancers in the United States. Only when Black patients achieve the highest income levels do they have similar survival levels to white patients with the lowest income.
