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Racial and Ethnic Variation in Survival in Early-Onset Colorectal Cancer
Joshua Demb1,2, Scarlett L Gomez3,4, Alison J Canchola3
1Division of Gastroenterology, Department of Internal Medicine, University of California, San Diego, La Jolla.
JAMA Network Open
|November 22, 2024
Summary
Early-onset colorectal cancer (EOCRC) mortality is higher in Native Hawaiian or Other Pacific Islander and non-Hispanic Black populations. Social determinants of health contribute to these disparities in EOCRC outcomes.
Area of Science:
- Oncology
- Epidemiology
- Health Disparities
Background:
- Early-onset colorectal cancer (EOCRC) rates are rising, with significant variations across racial and ethnic groups.
- Limited data exist on EOCRC mortality differences, especially when disaggregating minority populations.
Purpose of the Study:
- To investigate racial and ethnic disparities in EOCRC mortality.
- To analyze the influence of clinical and sociodemographic factors on these mortality differences.
- To provide specific data on Native Hawaiian or Other Pacific Islander and diverse Asian American groups.
Main Methods:
- Population-based cohort study using California Cancer Registry data (2000-2019).
- Included individuals aged 18-49 diagnosed with EOCRC.
- Cox proportional hazards regression models were used to assess associations between race/ethnicity and mortality, with sequential adjustment for covariates.
Main Results:
- Compared to non-Hispanic White individuals, higher EOCRC mortality was observed in Native Hawaiian or Other Pacific Islander (AHR, 1.34) and non-Hispanic Black (AHR, 1.18) populations.
- Hispanic individuals showed higher mortality in initial models, but this disappeared after adjusting for neighborhood socioeconomic status.
- Disaggregation of Asian American groups showed heterogeneity, with no single group exhibiting increased mortality after full adjustment.
Conclusions:
- Racial and ethnic disparities in EOCRC mortality are significant, particularly affecting Native Hawaiian or Other Pacific Islander and non-Hispanic Black individuals.
- Social determinants of health play a crucial role in explaining these observed mortality differences.
- Targeted interventions addressing social and economic factors are needed to reduce EOCRC disparities.
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