Fwelo Pierre, Adekunle Toluwani E, Adekunle Tiwaladeoluwa B, Garza Ella R, Huang Emily, Lawrence Wayne R, Ewing Aldenise P
Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA.
Department of Psychology, Public Health Program, Calvin University School of Health, Grand Rapids, Michigan, USA.
Cancer Med. 2025 Mar;14(5):e70612. doi: 10.1002/cam4.70612.
Non-Hispanic Black (Black) colorectal cancer (CRC) patients have a higher risk of mortality than most other racial/ethnic groups. Limited studies examine the contribution of socioeconomic (SES), clinicopathologic, or treatment variations to mortality disparities. This retrospective cohort investigation examined the extent to which SES, clinicopathologic, and treatment factors explain racial/ethnic differences in CRC mortality.
We studied 146,515 individuals, 18+ years old, with a confirmed diagnosis of CRC within 2010-2017, identified from the Surveillance, Epidemiology, and End Results (SEER) database. We performed Cox regression analyses to examine the association of race and ethnicity, surgery type, and tumor site with all-cause mortality and CRC-specific mortality. We then performed mediation analysis to quantify the extent to which mortality differences were mediated by SES, clinicopathologic, and treatment factors.
Black patients had a significantly higher hazard of all-cause mortality than non-Hispanic White (White) patients. The White versus Black patients' comparison demonstrated that variations in SES and clinicopathologic factors significantly explained 46.63% (indirect effect HR: 0.92, 95% CI 0.91-0.93) and 10.87% (indirect effect HR: 0.98, 95% CI 0.97-0.99) of the excess all-cause mortality among Black patients, respectively. The Hispanic versus Black comparisons identified SES as the most influential mediator, explaining 19.68% of the excess all-cause mortality. The proportions mediating for CRC-specific mortality showed comparable outcomes to all-cause mortality.
Black patients had a greater risk for all-cause mortality and CRC-specific mortality attributed to SES and clinicopathologic variations compared to other racial/ethnic groups. Future studies should investigate equity in healthcare through interventions addressing SES-related disparities.
非西班牙裔黑人（黑人）结直肠癌（CRC）患者的死亡风险高于大多数其他种族/族裔群体。仅有有限的研究探讨了社会经济（SES）、临床病理或治疗差异对死亡率差异的影响。这项回顾性队列研究调查了SES、临床病理和治疗因素在多大程度上解释了结直肠癌死亡率的种族/族裔差异。
我们研究了2010年至2017年期间确诊为CRC的146,515名18岁及以上个体，这些个体来自监测、流行病学和最终结果（SEER）数据库。我们进行了Cox回归分析，以研究种族和族裔、手术类型和肿瘤部位与全因死亡率和CRC特异性死亡率之间的关联。然后，我们进行了中介分析，以量化SES、临床病理和治疗因素介导死亡率差异的程度。
黑人患者的全因死亡风险显著高于非西班牙裔白人（白人）患者。白人患者与黑人患者的比较表明，SES和临床病理因素的差异分别显著解释了黑人患者全因死亡率过高的46.63%（间接效应HR：0.92，95%CI 0.91-0.93）和10.87%（间接效应HR：0.98，95%CI 0.97-0.99）。西班牙裔患者与黑人患者的比较确定SES是最有影响力的中介因素，解释了全因死亡率过高的19.68%。介导CRC特异性死亡率的比例与全因死亡率的结果相当。
与其他种族/族裔群体相比，黑人患者由于SES和临床病理差异而面临更高的全因死亡率和CRC特异性死亡率风险。未来的研究应通过解决与SES相关的差异的干预措施来调查医疗保健中的公平性。
