Skip to main content
SpringerLink
Log in

Availability of Primary Care Physicians and Racial Disparities in Colorectal Cancer-Related Mortality in the United States

Journal of Gastrointestinal Cancer (2023)Cite this article

Abstract

Introduction

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States (US), however racial disparities in outcomes persist. We sought to assess the correlation of availability of primary care physicians (PCPs) and racial disparities in CRC-related mortality.

Methods

We studied the correlation between age-adjusted incidence and mortality rates of CRC among all 50 states and the District of Columbia (D.C.) from the Center for Disease Control (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) with the number of actively practicing PCPs in all 50 states and D.C. from the Association of American Medical Colleges (AAMC) State Physician Workforce Data Report. Pearson’s coefficient was used to study correlations and the two-sample t test was used for comparing state-level PCP/CRC ratios between the two groups. Statistical analysis was performed using VassarStats.

Results

The mean AAMR per 100,000 population for CRC was significantly higher among AA versus White populations (t = 5.79, p < 0.001). Higher state-wide PCP per CRC case ratio correlated with lower state-wide CRCrelated mortality (r = −0.36, p = 0.011). The mean PCP per CRC case ratio was significantly lower among AA compared to White populations (t = −15.95, p < 0.0001). Higher PCP per CRC case ratio correlated with lower CRC-related mortality among both White (r = −0.64, p < 0.0001) and AA (r = −0.57, p = 0.0002) populations.

Conclusions

These findings suggest that racial disparities in CRC-related mortality may at least in part be related to lower availability of PCPs. Efforts focused on the development of strategies focused on improving access to primary care may help bridge racial disparities in CRC-related outcomes.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

Availability of Data and Materials

Data used for this analysis are publicly available at https://wonder.cdc.gov/ (CDC Wonder database) and https://www.aamc.org/data-reports/workforce/report/state-physician-workforce-data-report (AAMC state physician workforce data report).

References

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7–33.

    Article  PubMed  Google Scholar 

  2. Augustus GJ, Ellis NA. Colorectal cancer disparity in African Americans: Risk factors and carcinogenic mechanisms. Am J Pathol. 2018;188(2):291–303.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Halm EA, Beaber EF, McLerran D, Chubak J, Corley DA, Rutter CM, Doubeni CA, Haas JS, Balasubramanian BA. Association between primary care visits and colorectal cancer screening outcomes in the era of population health outreach. J Gen Intern Med. 2016;31(10):1190–7.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Landon BE, Onnela JP, Meneades L, O’Malley AJ, Keating NL. Assessment of racial disparities in primary care physician specialty referrals. JAMA Netw Open. 2021;4(1):e2029238.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Singal AK, Lin YL, Kuo YF, Riall T, Goodwin JS. Primary care physicians and disparities in colorectal cancer screening in the elderly. Health Serv Res. 2013;48(1):95–113.

    Article  PubMed  Google Scholar 

  6. Doubeni CA, Corley DA, Zhao W, Lau Y, Jensen CD, Levin TR. Association between improved colorectal screening and racial disparities. N Engl J Med. 2022;386(8):796–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Hematology, Oncology and Blood and Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Udhayvir Singh Grewal & Naomi Fei

  2. University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA

    Udhayvir Singh Grewal & Naomi Fei

  3. Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Manik Aggarwal

  4. Division of Hematology and Oncology, Louisiana State University Health Sciences Center, Shreveport, LA, USA

    Shiva Jashwanth Gaddam

  5. Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH, USA

    Prabhat Kumar

  6. Department of Gastroenterology and Hepatology, Virginia Tech Carillion Clinic, Roanoke, VA, USA

    Subhash Chandra Garikipati

Authors
  1. Udhayvir Singh Grewal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Manik Aggarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shiva Jashwanth Gaddam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Prabhat Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Subhash Chandra Garikipati
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Naomi Fei
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

USG, MA, and SJG contributed to collection of data, data analysis, and manuscript writing and review. PK and SCG contributed to data analysis and manuscript writing and review. NF contributed to conceptualization and manuscript writing and review.

Corresponding author

Correspondence to Naomi Fei.

Ethics declarations

Competing Interests

The authors declare no competing interests.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The present analysis was presented in abstract form at the Annual AACR meeting held in Orlando, FL in April, 2023.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Grewal, U.S., Aggarwal, M., Gaddam, S.J. et al. Availability of Primary Care Physicians and Racial Disparities in Colorectal Cancer-Related Mortality in the United States. J Gastrointest Canc (2023). https://doi.org/10.1007/s12029-023-00956-x

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12029-023-00956-x

Keywords

search

Navigation