Ethnic and Socioeconomic Disparities in the Staging, Treatment, and Overall Survival of Colorectal Cancer Patients in Hawai‘i

Abstract

There has been a decline in colorectal cancer (CRC) mortality rates, which reflects the declining incidence rates and medical advances in early detection and treatment. Despite this progress, CRC incidence and mortality varies considerably by ethnicity and socioeconomic status (SES). Evidence also shows that these medical advances are significantly under-utilized in vulnerable populations including minority and less affluent groups. In Hawai‘i, incidence rates are highest in Japanese Americans, and the majority of late stage CRC are diagnosed in Native Hawaiian/Pacific Islanders (NHPIs), who also have the highest mortality from this disease.The purpose of this study was to investigate ethnic and socioeconomic disparities in the staging, treatment, and overall survival of CRC patients in Hawaiʻi. This study was a retrospective analysis of CRC patients who have been diagnosed and/or treated at The Queen’s Medical Center (QMC) in Honolulu, Hawaiʻi. Data was collected and analyzed from 1,939 CRC patients from all islands of Hawaiʻi who were seen at QMC from January 1, 2007 to December 31, 2018. Both ethnicity (p=0.0499) and insurance (p=0.0005) were significantly associated with AJCC staging. NHPIs and individuals who were under-insured were more likely to be diagnosed with an AJCC stage 4. SES was found to have a significant effect on overall survival (p<0.0001), date of initial diagnosis to date of first treatment (p<0.0001), date of initial diagnosis to date of surgery (p<0.0001), and date of surgery to date of first chemotherapy (p<0.0001), whereas ethnicity had no significant effect. Ethnic disparities are slowly diminishing, whereas socioeconomic disparities persist. The results of this study may be applicable to other underserved populations--particularly other minority ethnic groups and those of low SES. Increasing health discussions and promoting CRC screening within these high-risk groups, lowering financial barriers, and increasing access to healthcare for the under-insured could potentially increase screening participation, which can ultimately address and reduce any ethnic or socioeconomic disparities in all CRC patients.