Colorectal cancer survival disparities in the five regions of Georgia

Meng-Han Tsai; Daramola N Cabral; Caitlyn Grunert; Justin X Moore

doi:10.1371/journal.pone.0301027

Colorectal cancer survival disparities in the five regions of Georgia

PLoS One. 2024 Mar 28;19(3):e0301027. doi: 10.1371/journal.pone.0301027. eCollection 2024.

Authors

Meng-Han Tsai^{1

2}, Daramola N Cabral^{3

4}, Caitlyn Grunert⁵, Justin X Moore⁶

Affiliations

¹ Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Augusta University, Augusta, Georgia, United States of America.
² Georgia Prevention Institute, Augusta University, Augusta, Georgia, United States of America.
³ Department of Health, Human Services, and Public Policy, College of Health Sciences and Human Services, California State University, Monterey Bay, Seaside, California, United States of America.
⁴ African Caribbean Cancer Consortium, Philadelphia, Pennsylvania, United States of America.
⁵ Department of Health Management and Policy, University of Kentucky, Lexington, Kentucky, United States of America.
⁶ Center for Health Equity Transformation, Department of Behavioral Science, Department of Internal Medicine, Markey Cancer Center, University of Kentucky College of Medicine, Lexington, Kentucky, United States of America.

Abstract

Background/objective: The objective of this study was to examine 5-year colorectal cancer survival rates. We also determined whether demographics, tumor characteristics, and treatment modality were associated with 5-year CRC survival in the Clayton, West Central, East Central, Southeast, and Northeast Georgia regions because the significant higher CRC mortality rates in these regions in comparison to the overall rates in the State of Georgia.

Methods: We conducted a retrospective cohort analysis using data from the 1975-2016 Surveillance, Epidemiology, and End Results program aggregated CRC patients to these five regions. Five-year CRC survival was calculated and stratified by the five regions of Georgia, using the Kaplan-Meier method with log-rank test. Cox proportional hazard regression was used to examine the mentioned association in these five regions.

Results: Among 11,023 CRC patients, 5-year CRC survival was lowest in Clayton (65.9%) compared to the West Central (69.0%), East Central (68.2%), Southeast (70.5%), and Northeast regions (69.5%) (p-value = 0.02). In multivariable analysis, greater risk of CRC death was found in the Clayton region compared to the West Central (HR, 1.12; 95%, 1.00-1.25) region when adjusting for demographics, tumor characteristics, and treatment modality. Among Clayton Georgians, age of 75+ years (HR, 2.13; 95%, 1.56-2.89), grade 3 & 4 tumors (HR, 2.22; 95%, 1.64-3.00), and distant stage (HR, 20.95; 95%, 15.99-27.45) were negatively associated with CRC survival.

Conclusion: We observed place-based differences in CRC survival with significantly lower survival rates in the Clayton region. Factors associated with higher risk of CRC death include older age at diagnosis, high-grade tumors, and distant stage CRC among Clayton Georgians. Our study provides important evidence to all relevant stakeholders in furthering the development of culturally tailored CRC screening interventions aimed at CRC early detection and improved outcomes.

Copyright: © 2024 Tsai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

MeSH terms

Aged
Cohort Studies
Colorectal Neoplasms* / epidemiology
Colorectal Neoplasms* / therapy
Georgia / epidemiology
Health Status Disparities*
Humans
Retrospective Studies
Survival Rate

Grants and funding

This research was supported at least in part through the Georgia Cancer Center Paceline funding mechanism at Augusta University (principal investigator: Meng-Han Tsai, MCGFD01050). In addition, Justin X. Moore was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number K01MD015304. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.