Social Factors Likely Explain Colon Ca Racial Disparities

HOUSTON—After controlling for socioeconomic status (SES) and treatment, African-Americans have only a marginally increased risk of death from colorectal cancer, according to a meta-analysis. Its authors suggest that efforts to eliminate socioeconomic and healthcare inequalities would significantly reduce the disease's mortality gap between blacks and whites. "Only a handful of studies have addressed racial disparities in survival for colon cancer by adequately incorporating both treatment and SES, in addition to factors on stage, grade, and co-morbidity," said Xianglin L. Du, MD, PhD, who conducted the study with colleagues from the School of Public Health, University of Texas Health Sciences Center at Houston. The report (on-line at DOI: 10.1002/cncr.22668) will appear in the June issue of Cancer.

The authors aggregated and analyzed data from 10 studies of colorectal cancer patients in which the investigators had adjusted for SES and treatment, and then focused on the association between race/ethnicity and surviving colorectal cancer.The pooled hazard ratio (HR) for blacks vs whites was 1.14 for all-cause mortality and 1.13 for colon-cancer-specific mortality. The test of homogeneity of HR was significant across the nine studies of all-cause mortality but not across the five studies of colon-cancer-specific mortality. The study showed that racial differences in colon cancer survival largely result from racial differences in SES, Dr. Du said, and that "the marginal remaining disadvantages for African-Americans are likely to be explained by factors related to low SES."