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Racial Disparities in Colorectal Cancer Mortality: the Role of Endoscopy Wait-Time and Stage at Diagnosis

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Abstract

Introduction

In Western Washington (WA), colorectal cancer (CRC) mortality between 2012 and 2016 was highest in American Indian/Alaska Natives (AI/AN) and African-Americans (AA) at 20.7 and 18.7, respectively, compared with non-Hispanic Whites at 14.1/100,000 people. We hypothesized that time from billed encounters for CRC-associated symptoms to endoscopy completion or CRC stage at diagnosis contributed to observed differences.

Methods

Using administrative insurance claims linked to WA cancer registry data, we performed a retrospective cohort study of patients diagnosed with CRC between 2011 and 2017, with continuous insurance for 15 months prior to diagnosis and a billed encounter for CRC-associated symptoms. We determined the wait-time (days) and stage at diagnosis and conducted logistic regression analysis to identify the factors associated with endoscopy completion.

Results

Of the 3461 CRC patients identified, 57% had stage 2 or 3 disease with no differences in stage by race, and 84% completed an endoscopy after a billed encounter for CRC-associated symptoms. The median wait-time to endoscopy was 52 days (IQR 14–218) without differences by race. Compared with patients diagnosed with stage 1 CRC, patients with stage 4 CRC were more likely to complete an endoscopy within the first quartile of time (22.2% vs. 17.4%, p < 0.01). Living arrangement, insurance type, and comorbidity, but not race, were significant factors associated with endoscopy completion.

Conclusions

We found no statistically significant differences in time from billed CRC-associated symptoms to endoscopy completion or in CRC stage among AA and AI/AN compared to Whites. This suggests that other factors are more likely to contribute to observed mortality disparities.

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Guarantor of the Article

Rachel Issaka, MD, MAS

Funding

This research was supported by the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA015704. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA

    Rachel B. Issaka

  2. Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA

    Rachel B. Issaka, Li Li, Catherine Fedorenko & Scott D. Ramsey

  3. Division of Gastroenterology, University of Washington School of Medicine, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA

    Rachel B. Issaka, Cynthia W. Ko & John M. Inadomi

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  1. Rachel B. Issaka
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Contributions

Study concept and design: Issaka.

Acquisition of data: Issaka, Li, Fedorenko.

Statistical analysis: Issaka, Li.

Drafting of the manuscript: Issaka.

Critical revision of the manuscript for important intellectual content: All authors.

Approval of the final manuscript: All authors.

Corresponding author

Correspondence to Rachel B. Issaka.

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Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Fred Hutchinson Institutional Review Board, IR File #8694) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All authors declare that they have no conflict of interest.

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Issaka, R.B., Li, L., Fedorenko, C. et al. Racial Disparities in Colorectal Cancer Mortality: the Role of Endoscopy Wait-Time and Stage at Diagnosis. J. Racial and Ethnic Health Disparities 7, 967–974 (2020). https://doi.org/10.1007/s40615-020-00721-x

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  • DOI: https://doi.org/10.1007/s40615-020-00721-x

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