Health Disparities
A Population-Based Retrospective Cohort Study on Colorectal Cancer Survival in Kentucky Jemal Gishe* Jemal Gishe Francis Pleban Mohamed Kanu Elizabeth Brown Meng-Han Tsai
Background: Colorectal cancer (CRC) mortality in Kentucky exceeds the national average, with some recent studies indicating an increase of up to 29.6%. Non-Hispanic Blacks (NHBs) and rural residents are disproportionately affected, experiencing higher CRC incidence and poorer survival outcomes. This study aims to identify factors contributing to the elevated CRC mortality in Kentucky.
Methods: This retrospective cohort study analyzed Surveillance, Epidemiology, and End Results (SEER) data from 2000 to 2021, including 42,963 eligible CRC patients from Kentucky. Demographic characteristics, diagnostic outcomes, and treatment modalities were examined. Kaplan-Meier and Cox regression model were used.
Results: Among patients, the highest proportion of distant CRC diagnoses was observed in NHBs (17.8%), while the lowest was in non-Hispanic Others (NHOs) (11.9%) (P<0.01). NHB patients also had the highest CRC mortality rate (42.7%) compared to NHOs (22.9%) (P<0.01). Unadjusted survival time was shortest for NHBs (70.6 months) and longest for NHOs (81.3 months) (P<0.01). Cox regression analysis (all P-values<0.01) revealed that counties not adjacent to metropolitan areas had a 13% higher mortality risk than large metropolitan areas, HR=1.13 CI(1.09, 1.18). NHBs had an 18% higher CRC mortality risk compared to non-Hispanic Whites, HR=1.18 CI(1.11, 1.26). Patients diagnosed with regional or distant stages had 165% (HR=2.65 CI 2.51, 2.80) and 853% (HR=9.53 CI 8.99, 10.10) higher mortality risks, respectively, compared to those with localized disease. Additionally, patients not recommended or refused surgery had a 233% higher mortality risk, HR=3.33 CI(3.18, 3.48).
Conclusion: This study identifies key factors influencing CRC mortality in Kentucky, such as being NHB, rural residency, late-stage diagnosis, and lack of surgical options. These findings highlight the need for targeted public health strategies and policy changes to address CRC-related health disparities in Kentucky.