Heterogeneity in the Survival Benefit of Guideline-Concordant Care across Racial and Ethnic Groups with Colorectal Cancer.

Sabuncuoglu M. Z., Zihni I.

Journal of racial and ethnic health disparities, 2026 (SSCI, Scopus)

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası:
  • Basım Tarihi: 2026
  • Doi Numarası: 10.1007/s40615-026-03248-9
  • Dergi Adı: Journal of racial and ethnic health disparities
  • Derginin Tarandığı İndeksler: Social Sciences Citation Index (SSCI), Scopus, CINAHL, EMBASE, MEDLINE, Psycinfo, Natural Science Collection (ProQuest), Social Science Premium Collection (ProQuest), Health Research Premium Collection (ProQuest), Sociology Database (ProQuest)
  • Akdeniz Üniversitesi Adresli: Evet

Özet

Purpose Racial/ethnic disparities in colorectal cancer mortality persist in the United States despite treatment advances. We examined racial/ethnic differences in guideline-concordant care (GCC) receipt and cancer-specific mortality, estimated the proportion of the Black-White disparity mediated through GCC, and tested for heterogeneity in the GCC-survival association across groups.

Methods Population-based cohort study using the Surveillance, Epidemiology, and End Results (SEER) Program. Adults with a first primary colorectal adenocarcinoma diagnosed 2010–2017 were included (N = 45,267). GCC was operationalized as a composite score (0–4) per NCCN recommendations. The primary outcome, cancer-specific mortality (CSM), was analyzed using Fine-Gray subdistribution hazard models. Race/ethnicity × GCC interactions were tested by likelihood ratio test; causal mediation decomposed effects into mediated and direct components.

Results Among 45,267 patients (52% male), CSM occurred in 10,478 (23%) over a median 77 months. GCC receipt differed significantly across groups (all p < 0.001). Non-Hispanic Black patients had higher adjusted CSM than White patients (SHR 1.20, 95% CI 1.11–1.28); Asian/PI patients had lower CSM (SHR 0.86, 95% CI 0.78–0.95). A significant race × GCC interaction was identified (p = 0.0036), with a stronger GCC-CSM association among Black than White patients (interaction HR 0.907, 95% CI 0.847–0.971). GCC differences accounted for only 2.2% (95% CI 0.8–4.5%) of the Black-White disparity.

Discussion Racial/ethnic disparities in colorectal cancer mortality were not substantially explained by differences in GCC receipt. A significant race/ethnicity × GCC interaction indicated that Black patients derived greater survival benefit per care component. Equitable care delivery is important but insufficient to eliminate persistent disparities; structural and social determinants must also be addressed.