Effects of Race and Gender on Colorectal Cancer: Patients, Clinic, and Hospital Visits (2005-2011) in a Southern Regional Health Care Center

Abstract

Purpose: Colorectal cancer (CRC) rates vary depending on regional geographics, socioeconomic status, race, and gender. Historically, African Americans (AA) have been reported to have higher rates of CRC compared to Caucasian (W) men (62/100,000 vs. 51.5/100,000, respectively). AA women are also reportedly likely to be diagnosed with CRC compared to W women (47/100,000 vs. 38.5/100,000; CDC, 2007). These findings may reflect sampling of populations which lack equal representation of AA and W patients. Methods: To investigate whether these trends would differ in a population with an equal contribution of AA and W patients, we performed a retrospective analysis (2005-2011) of CRC at LSU Health Shreveport, a public health facility with an approximately equal W and AA patient base. We evaluated total number of annual cases of CRC; the proportion of W males, AA males, W females, and AA females per total annual cases; the number of clinic visits as a surrogate marker of disease severity; and the number of hospital admissions over this period. Results: We found that W males, W females, AA males, and AA females had similar annual cases per year (not significantly different among groups, W males = 56±6.8; W females = 52.9±6.7; AA males 48±3.8, AA females 60.9±9.8; Average ± standard error of mean). However, when these data were compared as a fraction of total annual CRC cases we found that AA males represented the lowest proportion of annual cases, which was significantly lower than AA females (22.6±1% vs. 27.3±1.5%; p<0.05). We also considered clinic visits as a surrogate marker of disease activity in these populations. Among patients presenting with CRC, AA females had the highest number of annual clinic visits, followed by AA males, W females, and W males. By comparison, when we considered the proportion of hospital visits as a proportion by race and gender, W females were found to be the group with the lowest annual hospitalizations. Conclusion: Historically, the incidence of CRC is thought to vary depending on region, race, gender, and SES. The proportion between W and AA population representation in each region area may influence the apparent incidence of CRC. The patient base of LSU Health parallels the local demographic, which has roughly equal contributions of W and AA individuals. Surprisingly, in our analysis we found the annual cases of CRC in W males, W females, AA males, AA females were equivalent when compared over 2005-2011 (based on their annual cases per year). However, AA females sought medical attention more frequently, reporting more clinic visits compare to AA males or W patients. This may represent a ‘surrogate' marker of severe/more advanced disease in AA females. W females had the lowest percent of hospitalizations. Additional, longer and larger studies are needed to also consider the location and the staging of CRC at the time of diagnosis.