Symptomatic Colorectal Cancer Is Associated With Stage IV Diagnosis in Two Disparate Populations

Area of Science:

• Oncology
• Health Disparities
• Public Health

Background:

• Colorectal cancer (CRC) incidence and mortality are disproportionately higher in Black/African Ancestry (AA) populations compared to White/European Ancestry (EA) individuals in the U.S.
• Socioeconomic factors and race are complexly intertwined with CRC outcomes.
• Urban public hospitals (UH) serve different patient demographics than suburban university hospitals (SH).

Purpose of the Study:

• To disentangle the effects of race and socioeconomic factors on colorectal cancer (CRC) outcomes.
• To compare CRC patient demographics and disease stages between an urban public hospital (UH) and a suburban university hospital (SH).
• To assess the role of healthcare settings in contributing to or mitigating CRC disparities.

Main Methods:

• Manual chart review of 334 sporadic colorectal cancer (CRC) pathological diagnoses.
• Comparison of patient demographics, including race and insurance status, between an urban public hospital (UH) and a suburban university hospital (SH).
• Multivariable generalized linear model (GLM) analysis to identify factors associated with stage 4 CRC.

Main Results:

• Significant differences in Black/AA race (89.1% vs. 4.2%) and Medicaid/Self-pay insurance (85.0% vs. 14.9%) between UH and SH patients, respectively.
• A higher proportion of newly diagnosed metastatic stage 4 CRC patients presented at the UH (21%) compared to the SH (12.5%).
• Symptom presence was the only significant predictor of stage 4 CRC (OR 7.94, p=0.0057), not hospital type, suggesting the UH may be mitigating disparities.

Conclusions:

• The urban public hospital (UH) appears to be contributing to reducing colorectal cancer (CRC) disparities, despite serving a higher-risk population.
• Initiating CRC screening at recommended ages for all populations is essential to decrease the incidence of metastatic disease at diagnosis.
• Further research is needed to fully understand and address the complex interplay of race, socioeconomic status, and healthcare access in CRC outcomes.