TY - JOUR
T1 - Race, Income, and Survival in Stage III Colon Cancer
T2 - CALGB 89803 (Alliance)
AU - Lee, Seohyuk
AU - Zhang, Sui
AU - Ma, Chao
AU - Ou, Fang Shu
AU - Wolfe, Eric G.
AU - Ogino, Shuji
AU - Niedzwiecki, Donna
AU - Saltz, Leonard B.
AU - Mayer, Robert J.
AU - Mowat, Rex B.
AU - Whittom, Renaud
AU - Hantel, Alexander
AU - Benson, Al
AU - Atienza, Daniel
AU - Messino, Michael
AU - Kindler, Hedy
AU - Venook, Alan
AU - Gross, Cary P.
AU - Irwin, Melinda L.
AU - Meyerhardt, Jeffrey A.
AU - Fuchs, Charles S.
N1 - Publisher Copyright:
© 2021 The Author(s). Published by Oxford University Press.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Background: Disparities in colon cancer outcomes have been reported across race and socioeconomic status, which may reflect, in part, access to care. We sought to assess the influences of race and median household income (MHI) on outcomes among colon cancer patients with similar access to care. Methods: We conducted a prospective, observational study of 1206 stage III colon cancer patients enrolled in the CALGB 89803 randomized adjuvant chemotherapy trial. Race was self-reported by 1116 White and 90 Black patients at study enrollment; MHI was determined by matching 973 patients' home zip codes with publicly available US Census 2000 data. Multivariate analyses were adjusted for baseline sociodemographic, clinical, dietary, and lifestyle factors. All statistical tests were 2-sided. Results: Over a median follow-up of 7.7 years, the adjusted hazard ratios for Blacks (compared with Whites) were 0.94 (95% confidence interval [CI] = 0.66 to 1.35, P =. 75) for disease-free survival, 0.91 (95% CI = 0.62 to 1.35, P =. 65) for recurrence-free survival, and 1.07 (95% CI = 0.73 to 1.57, P =. 73) for overall survival. Relative to patients in the highest MHI quartile, the adjusted hazard ratios for patients in the lowest quartile were 0.90 (95% CI = 0.67 to 1.19, Ptrend =. 18) for disease-free survival, 0.89 (95% CI = 0.66 to 1.22, Ptrend =. 14) for recurrence-free survival, and 0.87 (95% CI = 0.63 to 1.19, Ptrend =. 23) for overall survival. Conclusions: In this study of patients with similar health-care access, no statistically significant differences in outcomes were found by race or MHI. The substantial gaps in outcomes previously observed by race and MHI may not be rooted in differences in tumor biology but rather in access to quality care.
AB - Background: Disparities in colon cancer outcomes have been reported across race and socioeconomic status, which may reflect, in part, access to care. We sought to assess the influences of race and median household income (MHI) on outcomes among colon cancer patients with similar access to care. Methods: We conducted a prospective, observational study of 1206 stage III colon cancer patients enrolled in the CALGB 89803 randomized adjuvant chemotherapy trial. Race was self-reported by 1116 White and 90 Black patients at study enrollment; MHI was determined by matching 973 patients' home zip codes with publicly available US Census 2000 data. Multivariate analyses were adjusted for baseline sociodemographic, clinical, dietary, and lifestyle factors. All statistical tests were 2-sided. Results: Over a median follow-up of 7.7 years, the adjusted hazard ratios for Blacks (compared with Whites) were 0.94 (95% confidence interval [CI] = 0.66 to 1.35, P =. 75) for disease-free survival, 0.91 (95% CI = 0.62 to 1.35, P =. 65) for recurrence-free survival, and 1.07 (95% CI = 0.73 to 1.57, P =. 73) for overall survival. Relative to patients in the highest MHI quartile, the adjusted hazard ratios for patients in the lowest quartile were 0.90 (95% CI = 0.67 to 1.19, Ptrend =. 18) for disease-free survival, 0.89 (95% CI = 0.66 to 1.22, Ptrend =. 14) for recurrence-free survival, and 0.87 (95% CI = 0.63 to 1.19, Ptrend =. 23) for overall survival. Conclusions: In this study of patients with similar health-care access, no statistically significant differences in outcomes were found by race or MHI. The substantial gaps in outcomes previously observed by race and MHI may not be rooted in differences in tumor biology but rather in access to quality care.
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U2 - 10.1093/jncics/pkab034
DO - 10.1093/jncics/pkab034
M3 - Article
C2 - 34104867
AN - SCOPUS:85131602148
SN - 2515-5091
VL - 5
JO - JNCI Cancer Spectrum
JF - JNCI Cancer Spectrum
IS - 3
M1 - pkab034
ER -