The role of socioeconomic disparity in colorectal cancer stage at presentation

Abstract

Colorectal cancer, despite multiple screening measures being available, is the second leading cause of death due to cancer. Cancer stage at diagnosis is an important determinant of survival, where earlier stages have significantly increased rates of survival. By looking at various social health disparities (at a patient and geographic level) and their effect on stage at presentation, we will gain a better understanding of the effect they have on cancer outcomes. Data were collected from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database for the years 2007-2014. Covariates extracted were patient-level variables such as age, race, primary site, state/county, insurance status as well as county-level data which included percent urban population, median family income, rural-urban continuum code classification, percent of population that has not completed high school, percent of population below the poverty line, percent of population foreign-born, percent of language-isolated persons, and unemployment rate. The primary outcome analyzed was cancer staging at diagnosis. A χ² analysis and multivariate binary logistic regression was modeled to elucidate the associations between study covariates and late stage of cancer presentation. Chi-squared analysis demonstrated significant associations (at p < 0.05) between stage of diagnosis with race, age, insurance status, location of primary site, percent of population below poverty line, percent of language-isolated persons, and percent of unemployed. To help reduce these disparities, community resources and increased screening and prevention techniques must be implemented to target the unique populations at greatest risk for developing the disease.

Keywords: Cancer outcomes; Cancer risk factors; Cancer screening; Colorectal cancer; Social health disparities; Stage at diagnosis.