Abstract
Introduction: Long–standing disparities in colorectal cancer (CRC) outcomes and survival between Whites and Blacks have been observed. A person–centered approach using latent class analysis (LCA) is a novel methodology to assess and address CRC health disparities. LCA can overcome statistical challenges from subgroup analyses that would normally impede variable–centered analyses like regression. Aim was to identify risk profiles and differences in malignant CRC survivorship outcomes.Methods: We conducted an LCA on the Surveillance, Epidemiology, and End Results data from 1975 to 2016 for adults ≥18 (N = 525,245). Sociodemographics used were age, sex/gender, marital status, race, and ethnicity (Hispanic/Latinos) and stage at diagnosis. To select the best fitting model, we employed a comparative approach comparing sample-size adjusted BIC and entropy; which indicates a good separation of classes.Results: A four–class solution with an entropy of 0.72 was identified as: lowest survivorship, medium-low, medium-high, and highest survivorship. The lowest survivorship class (26% of sample) with a mean survival rate of 53 months had the highest conditional probabilities of being 76–85 years–old at diagnosis, female, widowed, and non-Hispanic White, with a high likelihood with localized staging. The highest survivorship class (53% of sample) with a mean survival rate of 92 months had the highest likelihood of being married, male with localized staging, and a high likelihood of being non-Hispanic White.Conclusion: The use of a person–centered measure with population-based cancer registries data can help better detect cancer risk subgroups that may otherwise be overlooked.
Highlights
Long–standing disparities in colorectal cancer (CRC) outcomes and survival between Whites and Blacks have been observed
Our findings revealed that disparities in CRC survival outcomes may not be attributable to race/ethnicity alone, but to other factors related to marital status for both males and females
Of interest is the fact that racial or sociodemographic disparities alone do not account for differences in invasive CRC survival
Summary
Long–standing disparities in colorectal cancer (CRC) outcomes and survival between Whites and Blacks have been observed. The reasons for the decline in CRC incidence and mortality rates include advancements in biomedical sciences, leading to early detection and diagnosis, as well as improved treatment, increased screening outreach on a population basis, and adherence to interventions on behavioral lifestyle risk factors like smoking cessation [1, 3]. Regardless of the decline in CRC incidence, mortality, and survival, geographical and racial/ethnic disparities persist [1, 3, 6,7,8,9,10,11,12]. In terms of race/ethnicity, evidence has shown that non-Hispanic Blacks and American Indians/Alaska Natives experience the highest CRC incidence and mortality rates, compared to nonHispanic Whites [1]. There is critical need for research to understand these disparities and to inform the development of interventions to reduce/eliminate them
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