Abstract
PurposeWe examined individual-level and neighborhood-level predictors of mortality in CRC patients diagnosed in Florida to identify high-risk groups for targeted interventions.MethodsDemographic and clinical data from the Florida Cancer Data System registry (2007–2011) were linked with Agency for Health Care Administration and US Census data (n = 47,872). Cox hazard regression models were fitted with candidate predictors of CRC survival and stratified by age group (18–49, 50–64, 65+).ResultsStratified by age group, higher mortality risk per comorbidity was found among youngest (21%), followed by middle (19%), and then oldest (14%) age groups. The two younger age groups had higher mortality risk with proximal compared to those with distal cancer. Compared with private insurance, those in the middle age group were at higher death risk if not insured (HR = 1.35), or received healthcare through Medicare (HR = 1.44), Medicaid (HR = 1.53), or the Veteran’s Administration (HR = 1.26). Only Medicaid in the youngest (52% higher risk) and those not insured in the oldest group (24% lower risk) were significantly different from their privately insured counterparts. Among 18–49 and 50–64 age groups there was a higher mortality risk among the lowest SES (1.17- and 1.23-fold higher in the middle age and 1.12- and 1.17-fold higher in the older age group, respectively) compared to highest SES. Married patients were significantly better off than divorced/separated (HR = 1.22), single (HR = 1.29), or widowed (HR = 1.19) patients.ConclusionFactors associated with increased risk for mortality among individuals with CRC included being older, uninsured, unmarried, more comorbidities, living in lower SES neighborhoods, and diagnosed at later disease stage. Higher risk among younger patients was attributed to proximal cancer site, Medicaid, and distant disease; however, lower SES and being unmarried were not risk factors in this age group. Targeted interventions to improve survivorship and greater social support while considering age classification may assist these high-risk groups.
Highlights
Colorectal cancer (CRC) is the second leading cause of cancer death for men and women combined in the U.S with 142,820 estimated incident cases and 50,830 deaths in 2013 [1]
Data were extracted from the Florida Cancer Data System (FCDS) for all cases of CRC incidence among Florida residents with age greater than or equal to 18 years, who were diagnosed between 2007 and 2011, and who had a valid 2010 census tract assignment based on geocoded addresses at the time of diagnosis (n = 47,872)
Hispanics compared to non-Hispanic Whites had a survival benefit with a Hazard Ratio (HR) of 0.85 but non-Hispanic Blacks were not significantly different from non-Hispanic Whites (p = 0.81)
Summary
Colorectal cancer (CRC) is the second leading cause of cancer death for men and women combined in the U.S with 142,820 estimated incident cases and 50,830 deaths in 2013 [1]. In the state of Florida in 2010, the age-adjusted incidence and mortality rates per 100,000 for CRC were 36.4 (95% Confidence Interval [CI] = 35.6–37.1) and 14.1 (95% CI = 13.7–14.6), respectively [2]. Adherence to screening guidelines leading to earlier detection has afforded patients long-term improvements in cancer-specific mortality risk [3,4]. Healthy People 2020 objectives target CRC-specific mortality reduction from 17.0 per 100,000, the 2007 mortality rate, to 14.5 per 100,000 in 2020 [6].
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