Coughlin Steven S, Tsai Meng-Han, Cortes Jorge, Bevel Malcolm, Vernon Marlo
Department of Biostatistics, Data Science and Epidemiology, Augusta University, Augusta, GA 30912, USA.
Georgia Prevention Institute, Augusta University, Augusta, GA 30912, USA.
Curr Oncol. 2025 Apr 23;32(5):248. doi: 10.3390/curroncol32050248.
Because of shared mechanisms such as decreased access to health care, rurality and poverty may act synergistically to decrease colorectal cancer (CRC) survival. We conducted a retrospective cohort analysis of SEER data (22 registries) with census tract-level measures of poverty/rurality for the period 2006-2015. Multivariable Cox proportional hazard regressions were applied to examine the independent and intersectional associations of persistent poverty and rurality on 5-year cause-specific CRC survival across five racial/ethnic groups. Among 532,868 CRC patients, non-Hispanic Blacks (NHB) demonstrated lower 5-year survival probability (64.2% vs. 68.3% in non-Hispanic Whites [NHW], 66.5% in American Indian/Alaska Natives [AI/AN], 72.1% in Asian/Pacific Islanders, and 68.7% in Hispanic groups) (-value < 0.001). In adjusted analysis, CRC patients living in rural areas with poverty were at a 1.2-1.6-fold increased risk of CRC death than those who did not live in these areas in five racial/ethnic groups. In particular, AI/AN patients living in rural areas with poverty were 66% more likely to die from CRC (95% CI, 1.32, 2.08). CRC patients who live in rural or poverty areas in SEER areas in the U.S. have a poorer survival compared with those who do not live in such areas regardless of race/ethnicity. Significantly greater risk of CRC death was observed in AI/ANs. Patient navigators, community education or screening, and other health care system interventions may be helpful to address these disparities by socioeconomic status, race, and geographic residence. Multi-level interventions aimed at institutional racism and medical mistrust may also be helpful.
由于存在诸如医疗保健可及性降低等共同机制，农村地区和贫困状况可能会协同作用，降低结直肠癌（CRC）患者的生存率。我们对2006年至2015年期间监测、流行病学与结果（SEER）数据库（22个登记处）的数据进行了回顾性队列分析，并采用普查区层面的贫困/农村地区指标进行衡量。运用多变量Cox比例风险回归分析，以检验持续贫困和农村地区状况对五个种族/族裔群体5年结直肠癌特定病因生存率的独立及交叉关联。在532,868例结直肠癌患者中，非西班牙裔黑人（NHB）的5年生存概率较低（非西班牙裔白人[NHW]为68.3%，非西班牙裔黑人则为64.2%；美国印第安人/阿拉斯加原住民[AI/AN]为66.5%；亚太岛民为72.1%；西班牙裔群体为68.7%）（P值<0.001）。在调整分析中，五个种族/族裔群体中，生活在贫困农村地区的结直肠癌患者的结直肠癌死亡风险比未生活在这些地区的患者高1.2至1.6倍。特别是，生活在贫困农村地区的美国印第安人/阿拉斯加原住民患者死于结直肠癌的可能性要高66%（95%置信区间，1.32, 2.08）。在美国SEER地区，无论种族/族裔如何，生活在农村或贫困地区的结直肠癌患者的生存率均低于未生活在这些地区的患者。美国印第安人/阿拉斯加原住民的结直肠癌死亡风险显著更高。患者导航员、社区教育或筛查以及其他医疗保健系统干预措施可能有助于解决这些因社会经济地位、种族和地理居住情况导致的差异。旨在消除制度性种族主义和医疗不信任的多层次干预措施可能也会有所帮助。
