Award Date

12-2010

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Epidemiology and Biostatistics

First Committee Member

Paulo Pinheiro, Chair

Second Committee Member

James Symanowski

Third Committee Member

Michelle Chino

Fourth Committee Member

Sheniz Moonie

Graduate Faculty Representative

Patricia Alpert

Number of Pages

49

Abstract

Different population groups across Nevada and throughout the United States suffer disproportionately from colorectal cancer and its after-effects. Overcoming cancer health disparities is important for lessening the burden of cancer. There has been an overall decline in the incidence of and mortality from colorectal cancer (CRC). This is likely due, in part, to the increasing use of screening procedures such as Fecal Occult Blood Test (FOBT) and/or endoscopy, which can reduce the risk of CRC mortality by fifty percent. Nevertheless, screening procedures are routinely used by only fifty percent of Americans aged fifty years and older. Despite overall mortality decreasing over time, there continues to be a widening disparity in CRC incidence and survival between races and ethnicities. To assess CRC survival disparities across race and ethnicity in Nevada, data from the statewide Nevada Central Cancer Registry (NCCR) was used. We examined a cohort of men and women [n=11,459] who were diagnosed with CRC from 1995 through 2006 in Nevada. Cause-specific survival analyses were performed to ascertain the determinants of CRC disparities. Hazard ratios were calculated and stratified by race/ethnicity groups. The five years age adjusted survival rates were compared for 1995 – 1998, and 1999 - 2001. In the univariate model type three tests (Wald=24.71, df=5, p=.0002), race/ethnicity was statistically significant implying that there are survival disparities between race/ethnicity groups. African Americans had 20.6% risk ratio of CRC death in relation to Whites [HR = 1.21, 95% CI=1.05 – 1.39]. However, after adjusting for gender, age groups, health insurance type, period of diagnosis, stage of diagnosis, and sub-location within the colon and rectum in a multivariate analysis, Blacks and Hispanics had an increased risk of death in relation to Whites [HR = 1.24, p=0.004 for Blacks, and Hispanics HR=1.12, p=0.04] . More aggressive screening and equal treatment opportunities would do much to remedy the survival disparity seen among race/ethnic groups.

Keywords

Colon (Anatomy) — Cancer; Colorectal Cancer; Cox Proportional Hazard; CRC; Minorities; Proportional hazards models; Racial and Ethnic Disparities; Survival Analysis

Disciplines

Biostatistics | Epidemiology | Oncology | Public Health | Vital and Health Statistics

Language

English


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