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An Interaction of Race and Ethnicity With Socioeconomic Status in Rectal Cancer Outcomes

Kim, Joseph MD*; Artinyan, Avo MD, MS; Mailey, Brian MD*; Christopher, Stefanie BS*; Lee, Wendy BA*; McKenzie, Shaun MD*; Chen, Steven L. MD, MBA; Bhatia, Smita MD, MPH§; Pigazzi, Alessio MD, PhD*; Garcia-Aguilar, Julio MD, PhD*

doi: 10.1097/SLA.0b013e3182111102

Objective: Because appropriate rectal cancer care and subsequent outcomes can be influenced by several variables, our objective was to investigate how race, ethnicity, and socioeconomic status (SES) may impact rectal cancer outcomes.

Background: The management of rectal cancer requires a multidisciplinary approach utilizing medical and surgical subspecialties.

Methods: We performed an investigation of patients with rectal adenocarcinoma from Los Angeles County from 1988 to 2006 using the Los Angeles County Cancer Surveillance Program. Clinical and pathologic characteristics were compared among groups and overall survival was stratified by race/ethnicity and SES.

Results: Of 9504 patients with rectal cancer, 53% (n = 4999) were white, 10% black, 18% Hispanic, and 14% Asian. Stratified by race/ethnicity, Asians had the best overall survival followed by Hispanics, whites, and blacks (median survival 7.7 vs. 5.7, 5.5, and 3.4 years, respectively; P < 0.001). Stratified by SES group, the highest group had the best overall survival followed by middle and lowest groups (median survival 8.4 vs. 5.1 and 3.8 years, respectively, P < 0.001). Similar results were observed for surgical patients. On multivariate analysis, race/ethnicity, and SES remained independent predictors of overall survival in patients with rectal adenocarcinoma. Furthermore, interaction analysis indicated that the improved survival for select racial/ethnic groups was not dependent on SES classification.

Conclusions: Within the diverse Los Angeles County population, both race/ethnicity, and SES result in inequities in rectal cancer outcomes. Although SES may directly impact outcomes via access to care, the reasons for the association between race/ethnicity and outcomes remain uncertain.

Racial and ethnic disparities in gastrointestinal cancer outcomes have been recognized. However, the impact of socioeconomic status (SES) on outcomes in the context of these racial/ethnic disparities has rarely been investigated. Here, we examined both race/ethnicity and SES in rectal cancer outcomes and observed improved survival for rectal cancer patients of select race/ethnicity even when we adjusted for SES.

*Division of Oncologic Surgery, Department of Surgery, City of Hope, Duarte, CA.

Michael E. DeBakey Department of Surgery and Houston Health Services & Research Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine; Houston, TX.

Department of Surgery, University of California-Davis, Sacramento, CA; and §Department of Population Sciences, City of Hope, Duarte, CA.

§Department of Population Sciences, City of Hope, Duarte, CA.

Reprints: Joseph Kim, MD, Department of Surgery, City of Hope, 1500 E Duarte Road, Duarte, CA 91010. E-mail:

Supported in part by the Houston VA HSR&D Center of Excellence (HFP90-020) for Dr. Avo Artinyan.

Presented in part at the Pacific Coast Surgical Association's 81st Annual Meeting, Kapalua, Maui, HI; February, 2010.

There are no conflicts of interest.

The original study of a retrospective cohort examines the roles of race and ethnicity and socioeconomic status in rectal cancer outcomes in Los Angeles County.

© 2011 Lippincott Williams & Wilkins, Inc.