Impact of ethnicity and insurance on colorectal cancer outcomes.

Abstract

3598 Background: Previous studies have demonstrated ethnic disparities in mortality rates among colorectal cancer patients. The following analysis was performed to quantify disparities in a diverse ethnic population and explore reasons for the demonstrated differences. Methods: Data from 4,232 consecutive colorectal cancer patients were collected from hospital tumor registries between 1990 and 2007. Measures of association (chi-square, Cox regression) were used to analyze differences in colorectal cancer mortality and ethnicity as well as factors hypothesized to contribute to cancer mortality including age at diagnosis, sex, area of residence, place of birth, insurance, site of disease, histologic grade, stage, and initial treatment. Results: Filipino and native Hawaiian patients were significantly younger than white patients at the time of diagnosis (p < 0.0005) and Native Hawaiians were more likely than other groups to be uninsured or covered by Medicaid (p < 0.0005). Although there were no differences in stage at diagnosis among the ethnic groups, Filipinos and Native Hawaiians more often received chemotherapy (p < 0.0005). Multivariate Cox regression revealed that Filipino [HR 1.7 (1.3-2.3, 95% CI), p < 0.0005] and Native Hawaiian [HR 1.6 (1.2-2.0, 95% CI), p = 0.001] ethnicity adversely impacted survival even after adjusting for age, stage, histologic grade, treatment and insurance status. Conclusions: Among colorectal cancer patients, ethnic disparities exist that cannot be solely explained by differences in clinical tumor characteristics, treatment or insurance status. Further study into molecular characteristics of tumors and utilization of healthcare services is warranted. No significant financial relationships to disclose.