Parisa Tehranifar1,2, Abhishek Goyal3, Jo C Phelan4, Bruce G Link3,4,5, Yuyan Liao3, Xiaozhou Fan3, Manisha Desai6, Mary Beth Terry3,7,8. 1. Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA. pt140@columbia.edu. 2. Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA. pt140@columbia.edu. 3. Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA. 4. Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA. 5. Department of Public Policy, University of California Riverside, Riverside, CA, USA. 6. Department of Medicine, Division of General Medical Disciplines, Stanford University, Palo Alto, CA, USA. 7. Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA. 8. The Imprints Center for Genetic and Environmental Lifecourse Studies, Columbia UniversityMailman School of Public Health, New York, NY, USA.
Abstract
PURPOSE: Racial disparities in cancer mortality may be greater for cancers that are amenable to available early detection and treatment (amenability level). We investigated whether these patterns vary by age at cancer diagnosis. METHODS: Using 5-year relative survival rates (5Y-RSR), we classified 51 cancer sites into least amenable, partly amenable, and mostly amenable cancers (<40%, 40-69%, ≥70% 5-YRS, respectively). We examined whether racial disparities in mortality rates (African-Americans, Asian/Pacific Islanders, Hispanics, whites), as estimated through Cox regression models, were modified by age at diagnosis and amenability level in 516,939 cancer cases diagnosed in 1995-1999. RESULTS: As compared with whites, all racial minority groups experienced higher cancer mortality rates in the youngest age group of 20-34 years. African-Americans and Hispanics diagnosed with partly and mostly amenable cancers had higher mortality rates relative to whites with cancers of the same amenability levels; further, these differences decreased in magnitude or reversed in direction with increasing age. In contrast, the racial differences in mortality were smaller and remained fairly constant across age groups for least amenable cancers. For example, in the youngest (20-34) and oldest (80-99) age groups, the adjusted hazard ratios (HRs) for African-Americans versus whites with least amenable cancers were, respectively, 1.26 (95% CI 1.02, 1.55) and 0.90 (95% CI 0.85, 0.96), while the HRs for African-Americans versus whites with mostly amenable cancers were 2.77 (95% CI 2.38, 3.22) and 1.07 (95% CI 0.98, 1.17). CONCLUSIONS: Cancer survival disadvantage for racial minorities is larger in younger age groups for cancers that are more amenable to medical interventions.
PURPOSE: Racial disparities in cancer mortality may be greater for cancers that are amenable to available early detection and treatment (amenability level). We investigated whether these patterns vary by age at cancer diagnosis. METHODS: Using 5-year relative survival rates (5Y-RSR), we classified 51 cancer sites into least amenable, partly amenable, and mostly amenable cancers (<40%, 40-69%, ≥70% 5-YRS, respectively). We examined whether racial disparities in mortality rates (African-Americans, Asian/Pacific Islanders, Hispanics, whites), as estimated through Cox regression models, were modified by age at diagnosis and amenability level in 516,939 cancer cases diagnosed in 1995-1999. RESULTS: As compared with whites, all racial minority groups experienced higher cancer mortality rates in the youngest age group of 20-34 years. African-Americans and Hispanics diagnosed with partly and mostly amenable cancers had higher mortality rates relative to whites with cancers of the same amenability levels; further, these differences decreased in magnitude or reversed in direction with increasing age. In contrast, the racial differences in mortality were smaller and remained fairly constant across age groups for least amenable cancers. For example, in the youngest (20-34) and oldest (80-99) age groups, the adjusted hazard ratios (HRs) for African-Americans versus whites with least amenable cancers were, respectively, 1.26 (95% CI 1.02, 1.55) and 0.90 (95% CI 0.85, 0.96), while the HRs for African-Americans versus whites with mostly amenable cancers were 2.77 (95% CI 2.38, 3.22) and 1.07 (95% CI 0.98, 1.17). CONCLUSIONS:Cancer survival disadvantage for racial minorities is larger in younger age groups for cancers that are more amenable to medical interventions.
Entities:
Keywords:
Age; Cancer mortality; Medical advances; Racial/ethnic disparities; Survival factors
Authors: Parisa Tehranifar; Alfred I Neugut; Jo C Phelan; Bruce G Link; Yuyan Liao; Manisha Desai; Mary Beth Terry Journal: Cancer Epidemiol Biomarkers Prev Date: 2009-09-29 Impact factor: 4.254
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