Characteristics of colorectal cancer survival in an urban county hospital

Purpose: Disparities in colorectal cancer (CRC) survival have been associated with race/ethnicity, screening, and insurance status, but less is known about how geographic and socioeconomic heterogeneity may modulate these factors. We examined CRC outcomes in an urban underserved population with sociodemographic factors distinctly different than those previously studied. Methods: In this 11-year retrospective study, the demographics and clinical features of 331 CRC patients from a Northern California urban county hospital were reviewed. Cox proportional hazards modeling was used to evaluate differences in 5-year mortality. Results: The study cohort consisted of 38 % Whites, 37 % Asians, 22 % Hispanics, and 4 % Blacks. Most of the patients either had government-sponsored insurance (62.5 %) or were uninsured (21.8 %). Compared to national SEER data, stage IV disease was more prevalent in our study cohort (37 vs 20 %) and the overall 5-year survival rate was worse (52.9 vs 64.3 %). CRC screening was associated with improved survival (hazard ratio (HR) 0.24, P = 0.002), while insurance status was not. In the multivariate analysis, advanced age (HR 2.48, confidence interval (CI) 1.39-4.42, P = 0.002) and late stage (stage IV: HR 32.46, CI 9.92-106.25, P < 0.001) predicted worse outcomes. Contrary to some population-based studies, Hispanics in our cohort had significantly better overall mortality compared to Whites (HR 0.46, CI 0.29-0.74, P = 0.001). Conclusions: Disparities in CRC outcomes for urban underserved populations persist. However, there is geographic and socioeconomic heterogeneity in factors that have been previously shown to contribute to mortality. Screening and therapeutic strategies formulated from larger population-based studies may not be generalizable to these unique subpopulations.