Introduction
Methods
Data source
Study cohort
Patient race and ethnicity
PRO measures
Covariates
Statistical analyses
Results
Study characteristics
Racial and ethnic group | ||||||
---|---|---|---|---|---|---|
Sample N = 1867 (100.00) | Non-Hispanic White N = 1485 (79.54) | Non-Hispanic Black N = 119 (6.37) | Hispanic N = 140 (7.50) | Non-Hispanic Asian N = 123 (6.59) | p-value | |
Age at CRC diagnosis | 0.0752 | |||||
65–74 years | 862 (46.17) | 660 (44.44) | 64 (53.78) | 72 (51.43) | 66 (53.66) | |
75–84 years | 781 (41.83) | 642 (43.23) | 46 (38.66) | 53 (37.86) | 40 (32.52) | |
85 + years | 224 (12.00) | 183 (12.32) | 9 (7.56) | 15 (10.71) | 17 (13.82) | |
Gender | 0.0005 | |||||
Male | 876 (46.92) | 708 (47.68) | 38 (31.93) | 79 (56.43) | 51 (41.46) | |
Female | 991 (53.08) | 777 (52.32) | 81 (68.07) | 61 (43.57) | 72 (58.54) | |
Percent of residents in neighborhood living in poverty | < 0.0001 | |||||
< 5% | 490 (26.25) | 431 (29.02) | 5 (4.20) | 19 (13.57) | 35 (28.46) | |
5% to < 10% | 519 (27.80) | 432 (29.09) | 10 (8.40) | 28 (20.00) | 49 (39.84) | |
10% to < 20% | 529 (28.33) | 426 (28.69) | 32 (26.89) | 45 (32.14) | 26 (21.14) | |
20% to 100% | 329 (17.62) | 196 (13.20) | 72 (60.50) | 48 (34.29) | 13 (10.57) | |
Medicare insurance type | < 0.0001 | |||||
Medicare advantage | 1067 (57.15) | 810 (54.55) | 75 (63.03) | 98 (70.00) | 84 (68.29) | |
Fee for service | 800 (42.85) | 675 (45.45) | 44 (36.97) | 42 (30.00) | 39 (31.71) | |
Education level | < 0.0001 | |||||
Less than high school | 504 (27.00) | 326 (21.95) | 64 (53.78) | 77 (55.00) | 37 (30.08) | |
High school | 640 (34.28) | 538 (36.23) | 31 (26.05) | 34 (24.29) | 37 (30.08) | |
High school or greater | 723 (38.73) | 621 (41.82) | 24 (20.17) | 29 (20.71) | 49 (39.84) | |
Number of comorbidities | 0.0216 | |||||
No comorbidities | 1367 (73.22) | 1105 (74.41) | 72 (60.50) | 102 (72.86) | 88 (71.54) | |
1 Comorbidity | 338 (18.10) | 255 (17.17) | 29 (24.37) | 26 (18.57) | 28 (22.76) | |
2 + Comorbidities | 162 (8.68) | 125 (8.42) | 18 (15.13) | 12 (8.57) | 7 (5.69) | |
Diagnosis to survey duration | 0.3831 | |||||
6–12 Months | 481 (25.76) | 380 (25.59) | 37 (31.09) | 33 (23.57) | 31 (25.20) | |
12–24 Months | 758 (40.60) | 619 (41.68) | 38 (31.93) | 54 (38.57) | 47 (38.21) | |
24–36 Months | 628 (33.64) | 486 (32.73) | 44 (36.97) | 53 (37.86) | 45 (36.59) | |
Tumor stage | 0.0239 | |||||
In Situ/localized | 1062 (56.88) | 863 (58.11) | 70 (58.82) | 74 (52.86) | 55 (44.72) | |
Regional | 805 (43.12) | 622 (41.89) | 49 (41.18) | 66 (47.14) | 68 (55.28) | |
Tumor grade | 0.0798 | |||||
Well differentiated | 220 (11.78) | 179 (12.05) | 17 (14.29) | 14 (10.00) | 10 (8.13) | |
Moderately differentiated | 1347 (72.15) | 1050 (70.71) | 90 (75.63) | 108 (77.14) | 99 (80.49) | |
Poorly differentiated/undifferentiated | 300 (16.07) | 256 (17.24) | 12 (10.08) | 18 (12.86) | 14 (11.38) | |
Tumor location | 0.0038 | |||||
Rectal | 435 (23.30) | 360 (24.24) | 14 (12.76) | 30 (21.43) | 31 (25.20) | |
Right-sided colon | 919 (49.22) | 734 (49.43) | 72 (60.50) | 66 (47.14) | 47 (38.21) | |
Left-sided colon | 513 (27.48) | 391 (26.33) | 33 (27.73) | 45 (31.43) | 45 (36.59) | |
Number of lymph nodes evaluated | 0.5376 | |||||
< 12 nodes evaluated | 833 (44.62) | 659 (44.38) | 53 (44.54) | 70 (50.00) | 51 (41.46) | |
≥ 12 nodes evaluated | 1034 (55.38) | 826 (55.62) | 66 (55.46) | 70 (50.00) | 72 (58.54) | |
Surgical approach | 0.0687 | |||||
Subtotal resection | 1753 (93.89) | 1384 (93.20) | 116 (97.48) | 133 (95.00) | 120 (97.56) | |
Total resection | 114 (6.11) | 101 (6.80) | 3 (2.52) | 7 (5.00) | 3 (2.44) | |
Received radiotherapy | 0.0499 | |||||
No | 1690 (90.52) | 1343 (90.44) | 114 (95.80) | 128 (91.43) | 105 (85.37) | |
Yes | 177 (9.48) | 142 (9.56) | 5 (4.20) | 12 (8.57) | 18 (14.64) |
Fair or poor general health status | Sample N = 1825 | p-value | Fair or poor mental health status | Sample N = 1782 | p-value | |
---|---|---|---|---|---|---|
Race and ethnicity | 0.0265 | 0.0331 | ||||
Non-Hispanic white | 491 (33.86) | 1450 | 168 (11.87) | 1415 | ||
Non-Hispanic black | 51 (44.35) | 115 | 16 (14.16) | 113 | ||
Hispanic | 60 (43.17) | 139 | 28 (20.59) | 136 | ||
Non-Hispanic Asian | 42 (34.71) | 121 | 16 (13.56) | 118 | ||
Age at CRC diagnosis | 0.0242 | < 0.001 | ||||
65–74 years | 273 (32.16) | 849 | 75 (9.08) | 826 | ||
75–84 years | 284 (37.37) | 760 | 116 (15.47) | 750 | ||
85 + years | 87 (40.28) | 216 | 37 (17.96) | 206 | ||
Gender | 0.3468 | 0.6474 | ||||
Male | 312 (36.41) | 857 | 104 (12.41) | 838 | ||
Female | 332 (34.30) | 968 | 124 (13.14) | 944 | ||
Percent of residents in neighborhood living in poverty | 0.0040 | 0.0044 | ||||
< 5% | 144 (30.00) | 480 | 42 (9.11) | 461 | ||
5% to < 10% | 170 (33.73) | 504 | 64 (12.96) | 494 | ||
10% to < 20% | 196 (37.84) | 518 | 65 (12.77) | 509 | ||
20% to 100% | 134 (41.49) | 323 | 57 (17.92) | 318 | ||
Medicare insurance type | 0.0751 | 0.1552 | ||||
Medicare advantage | 349 (33.56) | 1040 | 118 (11.80) | 1000 | ||
Fee for service | 295 (37.58) | 785 | 110 (14.07) | 782 | ||
Education level | < 0.0001 | < 0.0001 | ||||
Less than high school | 231 (47.05) | 491 | 99 (20.93) | 473 | ||
High school | 211 (33.71) | 626 | 74 (12.03) | 615 | ||
High school or greater | 202 (28.53) | 708 | 55 (7.93) | 694 | ||
Number of comorbidities | < 0.0001 | 0.0131 | ||||
No comorbidities | 438 (32.74) | 1338 | 169 (12.92) | 1308 | ||
1 Comorbidity | 112 (34.36) | 326 | 29 (9.24) | 314 | ||
2 + Comorbidities | 94 (58.39) | 161 | 30 (18.75) | 160 | ||
Diagnosis to survey duration | 0.4100 | 0.4388 | ||||
6–12 Months | 174 (37.58) | 463 | 48 (11.29) | 425 | ||
12–24 Months | 263 (35.21) | 747 | 94 (12.67) | 742 | ||
24–36 Months | 207 (33.66) | 615 | 86 (18.98) | 615 | ||
Tumor stage | 0.2243 | 0.5660 | ||||
In Situ/localized | 354 (34.10) | 1038 | 134 (13.19) | 1016 | ||
Regional | 290 (36.85) | 787 | 94 (12.27) | 766 | ||
Tumor grade | 0.4788 | 0.6259 | ||||
Well differentiated | 74 (34.42) | 215 | 26 (12.44) | 209 | ||
Moderately differentiated | 459 (34.75) | 1321 | 171 (13.21) | 1294 | ||
Poorly differentiated/undifferentiated | 111 (38.41) | 289 | 31 (11.11) | 279 | ||
Tumor location | 0.0389 | 0.7056 | ||||
Rectal | 166 (39.34) | 422 | 51 (12.53) | 407 | ||
Right-sided colon | 319 (35.60) | 896 | 118 (13.42) | 879 | ||
Left-sided colon | 159 (31.69) | 507 | 59 (11.90) | 496 | ||
Number of lymph nodes evaluated | 0.0018 | 0.0757 | ||||
< 12 nodes evaluated | 319 (39.19) | 814 | 113 (14.38) | 786 | ||
≥ 12 nodes evaluated | 325 (32.15) | 1011 | 115 (11.44) | 996 | ||
Surgical approach | 0.0439 | 0.1347 | ||||
Subtotal resection | 595 (34.71) | 1714 | 209 (12.49) | 1673 | ||
Total resection | 49 (44.14) | 111 | 19 (17.43) | 109 | ||
Received radiotherapy | 0.0961 | 0.1915 | ||||
No | 573 (34.69) | 1652 | 212 (13.13) | 1615 | ||
Yes | 71 (41.04) | 173 | 16 (9.58) | 167 |
Drivers of fair or poor health status
Fair or poor general health status OR (95% CI) | p-value | Fair or poor mental health status OR (95% CI) | p-value | |
---|---|---|---|---|
Model 1 (Race and ethnicity) | ||||
aRace and ethnicity | 0.0276 | 0.0367 | ||
Non-Hispanic White | 1.00 (Ref) | 1.0 (Ref) | ||
Non-Hispanic Black | 1.56 (1.06, 2.28) | 1.22 (0.70, 2.13) | ||
Hispanic | 1.48 (1.04, 2.11) | 1.92 (1.23, 3.01) | ||
Non-Hispanic Asian | 1.04 (0.70, 1.53) | 1.16 (0.67, 2.02) | ||
Model 2 (Race and ethnicity + clinical) | ||||
bRace and ethnicity | 0.0189 | 0.0391 | ||
Non-Hispanic White | 1.0 (Ref) | 1.0 (Ref) | ||
Non-Hispanic Black | 1.62 (1.10, 2.40) | 1.21 (0.69, 2.11) | ||
Hispanic | 1.49 (1.04, 2.13) | 1.92 (1.22, 3.00) | ||
Non-Hispanic Asian | 1.08 (0.72, 1.60) | 1.25 (0.71, 2.18) | ||
Model 3 (Race and ethnicity + clinical + sociodemographic) | ||||
cRace and ethnicity | 0.5251 | 0.2254 | ||
Non-Hispanic White | 1.0 (Ref) | 1.0 (Ref) | ||
Non-Hispanic Black | 1.25 (0.81, 1.92) | 0.83 (0.45, 1.53) | ||
Hispanic | 1.25 (0.86, 1.82) | 1.51 (0.93, 2.45) | ||
Non-Hispanic Asian | 1.14 (0.75, 1.71) | 1.33 (0.75, 2.37) |
Mortality and fair or poor health status
Variables | Self-reported health status up to 36 months from colorectal cancer diagnosis | |||
---|---|---|---|---|
Fair or poor general health status HR (95% CI) | p-value | Fair or poor mental health status HR (95% CI) | p-value | |
Fair or poor general health status* | 1.52 (1.31, 1.76) | < 0.0001 | N/A | |
Fair or poor mental health status* | N/A | 1.63 (1.34, 1.99) | < 0.0001 | |
Race/ethnicity | 0.0217 | 0.0210 | ||
Non-Hispanic White | 1.0 (Ref) | 1.0 (Ref) | ||
Non-Hispanic Black | 0.83 (0.59, 1.15) | 0.86 (0.62, 1.21) | ||
Hispanic | 0.83 (0.63, 1.09) | 0.78 (0.59, 1.04) | ||
Non-Hispanic Asian | 0.61 (0.43, 0.86) | 0.61 (0.43, 0.87) | ||
Age at survey | < 0.0001 | < .0001 | ||
65–74 years | 1.0 (Ref) | 1.0 (Ref) | ||
75–84 years | 1.72 (1.47, 2.02) | 1.73 (1.47, 2.04) | ||
85 + years | 3.10 (2.50, 3.83) | 3.17 (2.54, 3.96) | ||
Gender | 0.0003 | 0.0011 | ||
Male | 1.0 (Ref) | 1.0 (Ref) | ||
Female | 0.77 (0.66, 0.89) | 0.78 (0.67, 0.91) | ||
Neighborhood poverty level | 0.2858 | 0.2866 | ||
< 5% | 1.0 (Ref) | 1.0 (Ref) | ||
5 to < 10% | 1.21 (0.998, 1.48) | 1.22 (0.99, 1.49) | ||
10 to < 20% | 1.13 (0.93, 1.37) | 1.16 (0.95, 1.42) | ||
20 to 100% | 1.14 (0.90, 1.45) | 1.14 (0.90, 1.46) | ||
Medicare insurance type | 0.6536 | 0.3163 | ||
Medicare advantage | 1.0 (Ref) | 1.0 (Ref) | ||
Fee for service | 1.03 (0.90, 1.19) | 1.08 (0.93, 1.25) | ||
Education level | 0.0015 | 0.0011 | ||
Less than high school | 1.0 (Ref) | 1.0 (Ref) | ||
High school | 0.90 (0.75, 1.07) | 0.91 (0.76, 1.09) | ||
High school or greater | 0.72 (0.60, 0.86) | 0.71 (0.59, 0.86) | ||
Number of comorbidities | 0.7866 | 0.6295 | ||
No comorbidities | 1.0 (Ref) | 1.0 (Ref) | ||
1 Comorbidity | 0.94 (0.73, 1.19) | 0.95 (0.73, 1.23) | ||
2 + Comorbidities | 1.06 (0.77, 1.46) | 1.14 (0.83, 1.58) | ||
Diagnosis to survey duration | 0.0259 | 0.0351 | ||
6–12 Months | 1.0 (Ref) | 1.0 (Ref) | ||
12–24 Months | 0.82 (0.68, 0.97) | 0.83 (0.69, 0.995) | ||
24–36 Months | 0.79 (0.66, 0.95) | 0.78 (0.65, 0.95) | ||
Tumor stage | 0.0002 | < 0.0001 | ||
In Situ/localized | 1.0 (Ref) | 1.0 (Ref) | ||
Regional | 1.33 (1.14, 1.54) | 1.36 (1.17, 1.58) | ||
Tumor grade | 0.5752 | 0.4229 | ||
Well differentiated | 1.0 (Ref) | 1.0 (Ref) | ||
Moderately differentiated | 1.13 (0.90, 1.42) | 1.17 (0.93, 1.48) | ||
Poorly differentiated/undifferentiated | 1.13 (0.85, 1.50) | 1.16 (0.87, 1.55) | ||
Tumor location | 0.6215 | 0.6657 | ||
Rectal | 1.0 (Ref) | 1.0 (Ref) | ||
Right-sided colon | 0.90 (0.73, 1.11) | 0.91 (0.73, 1.13) | ||
Left-sided colon | 0.93 (0.74, 1.16) | 0.92 (0.73, 1.15) | ||
Lymphadenectomy | 0.1830 | 0.0514 | ||
< 12 nodes evaluated | 1.0 (Ref) | 1.0 (Ref) | ||
≥ 12 nodes evaluated | 0.90 (0.78, 1.05) | 0.86 (0.74, 1.00) | ||
Surgical approach | 0.0605 | 0.0556 | ||
Subtotal resection | 1.0 (Ref) | 1.0 (Ref) | ||
Total resection | 1.32 (0.99, 1.77) | 1.33 (0.99, 1.79) | ||
Received radiotherapy | 0.0245 | 0.0204 | ||
No | 1.0 (Ref) | 1.0 (Ref) | ||
Yes | 0.71 (0.53, 0.96) | 0.70 (0.51, 0.95) |