Colon cancer incidence and mortality rates are higher in blacks compared with whites, and new research shows that differences in health insurance coverage and tumor characteristics are largely responsible for these racial disparities in colon cancer survival.
Study investigator Helmneh M. Sineshaw, MD, MPH, of the American Cancer Society, and colleagues from the Dana-Farber Cancer Institute at Harvard Medical School, concluded that differences in insurance coverage account for about half of the survival disparity, while tumor characteristics account for a quarter.
“These findings reinforce the importance of equitable health insurance coverage to mitigate the survival disparity between black versus white CRC patients,” they wrote.
Sineshaw and colleagues evaluated data from the National Cancer Database to determine the impact of insurance, comorbidity, tumor characteristics and treatment on the colon cancer survival disparity between blacks and whites. They analyzed data on 199,098 patients aged 18 to 64 years diagnosed with single or first primary invasive CRC from 2004 through 2012 (16.7% black, 83.3% white).
They found that the absolute difference in 5-year survival was 9.2% (57.3% for blacks vs. 66.5% for whites; P < .0001), but this dropped by almost half to 4.9% after matching for health insurance coverage.
Additionally, the difference in survival dropped to 2.3% after matching for tumor characteristics.
The investigators calculated that differences in insurance coverage accounted for 54% of the excess mortality risk among black patients, while tumor characteristics accounted for 27% of the disparity.
They observed no changes in absolute difference in survival after matching for demographics or treatment.
“Affordable health insurance coverage for all populations could substantially reduce differences in survival times of black vs. white patients with CRC,” Sineshaw and colleagues concluded.
They added that further research is needed to understand the reasons for racial differences in tumor characteristics. – by Adam Leitenberger
Disclosures: The authors report no relevant financial disclosures.