Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
Greater Bay Area Cancer Registry, University of California, San Francisco, San Francisco, California.
Cancer Epidemiol Biomarkers Prev. 2020 Jun;29(6):1154-1161. doi: 10.1158/1055-9965.EPI-19-1544. Epub 2020 May 5.
Colorectal cancer incidence and mortality have declined with increased screening and scientific advances in treatment. However, improvement in colorectal cancer outcomes has not been equal for all groups and disparities have persisted over time.
Data from the California Cancer Registry were used to estimate changes in 5-year colorectal cancer-specific survival over three diagnostic time periods: 1997-2002, 2003-2008, and 2009-2014. Analyses included all patients in California with colorectal cancer as a first primary malignancy. Multivariable Cox proportional hazard regression models were used to evaluate the effect of race/ethnicity, insurance status, and neighborhood socioeconomic status (nSES) on 5-year colorectal cancer-specific survival.
On the basis of a population-based sample of 197,060 colorectal cancer cases, racial/ethnic survival disparities decreased over time among non-Hispanic Blacks (NHB) compared with non-Hispanic Whites (NHW), after adjusting for demographic, clinical, and treatment characteristics. For cases diagnosed 1997-2002, colorectal cancer-specific hazard rates were higher for NHB [HR, 1.12; 95% confidence interval (CI), 1.06-1.19] and lower for Asians/Pacific Islanders (HR, 0.92; 95% CI, 0.87-0.96) and Hispanics (HR, 0.94; 95% CI, 0.90-0.99) compared with NHW. In 2009-2014, colorectal cancer-specific HR for NHB was not significantly different to the rate observed for NHW (HR, 1.03; 95% CI, 0.97-1.10). There were no changes in disparities in nSES, but increasing disparities by health insurance status.
We found a decrease in survival disparities over time by race/ethnicity, but a persistence of disparities by neighborhood socioeconomic status and health insurance status.
Further investigation into the drivers for these disparities can help direct policy and practice toward health equity for all groups.
随着筛查的增加和治疗方面的科学进步，结直肠癌的发病率和死亡率有所下降。然而，并非所有人群的结直肠癌治疗效果都得到了改善，而且随着时间的推移，差异一直存在。
使用加利福尼亚癌症登记处的数据，估计三个诊断时间段内 5 年结直肠癌特异性生存率的变化：1997-2002 年、2003-2008 年和 2009-2014 年。分析包括加利福尼亚州所有首次诊断为结直肠癌的患者。使用多变量 Cox 比例风险回归模型评估种族/民族、保险状况和邻里社会经济地位（nSES）对 5 年结直肠癌特异性生存率的影响。
基于 197060 例结直肠癌病例的基于人群的样本，在调整了人口统计学、临床和治疗特征后，与非西班牙裔白人（NHW）相比，非西班牙裔黑人（NHB）的种族/民族生存差异随着时间的推移而减少。对于 1997-2002 年诊断的病例，NHB 的结直肠癌特异性危险比更高（HR，1.12；95%置信区间[CI]，1.06-1.19），而亚洲/太平洋岛民（HR，0.92；95%CI，0.87-0.96）和西班牙裔（HR，0.94；95%CI，0.90-0.99）的结直肠癌特异性危险比更低。在 2009-2014 年，NHB 的结直肠癌特异性 HR 与 NHW 观察到的比率无显著差异（HR，1.03；95%CI，0.97-1.10）。nSES 方面的差异没有变化，但医疗保险状况的差异在增加。
我们发现，随着时间的推移，种族/民族之间的生存率差异有所缩小，但邻里社会经济地位和医疗保险状况方面的差异仍然存在。
进一步研究这些差异的驱动因素可以帮助指导所有群体的政策和实践，实现健康公平。
