Lack of Reduction in Racial Disparities in Cancer-Specific Mortality Over a Twenty-Year Period
MetadataShow full item record
CitationWilhite, Tyler. 2015. Lack of Reduction in Racial Disparities in Cancer-Specific Mortality Over a Twenty-Year Period. Doctoral dissertation, Harvard Medical School.
AbstractBackground: It remains unknown how race-based differences in cancer outcomes have changed with time. We sought to explore racial disparities in cancer-specific mortality.
Methods: Using the Surveillance, Epidemiology and End Results Program, we identified 2,713,474 patients diagnosed in 1988-2007 with lung, breast, prostate, or colorectal cancer. The impact of race on cancer-specific mortality was assessed using Fine and Gray’s regression; an interaction model evaluated trends over time.
Results: African Americans presented with more advanced stage (p<0.001) and underwent definitive therapy less often (p<0.001) than whites. After adjustment for demographics and diagnosis-year, African Americans had higher estimates of cancer-specific mortality than whites for all cancers combined (HR 1.27, 95% CI 1.25-1.29, p<.001) and within each individual cancer (each p<0.05). These differences did not change significantly between 1988-1997 and 1998- 2007, except in breast cancer, wherein survival disparities increased. These findings remained significant after adjustment for stage at presentation and receipt of definitive therapy (HR for breast-mortality in African Americans versus whites: 1.37 from 1988-1997 and 1.53 from 1998- 2007, p-interaction <0.001).
Conclusions: The survival gap for African Americans has not closed over time and persists independent of stage and treatment, suggesting that additional strategies beyond screening and improving access to care are needed.
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:17295860