摘要：Objectives. We examined whether racial disparities in stage-specific colorectal cancer survival changed between 1960 and 2005. Methods. We used US Mortality Multiple-Cause-of-Death Data Files and intercensal estimates to calculate standardized mortality rates by gender and race from 1960 to 2005. We used Surveillance, Epidemiology, and End Results (SEER) data to estimate stage-specific colorectal cancer survival. To account for SEER sampling uncertainty, we used a bootstrap resampling procedure and fit a Cox proportional hazards model. Results. Between 1960–2005, patterns of decline in mortality rate as a result of colorectal cancer differed greatly by gender and race: 54% reduction for White women, 14% reduction for Black women, 39% reduction for White men, and 28% increase for Black men. Blacks consistently experienced worse rates of stage-specific survival and life expectancy than did Whites for both genders, across all age groups, and for localized, regional, and distant stages of the disease. Conclusions. The rates of stage-specific colorectal cancer survival differed among Blacks when compared with Whites during the 4-decade study period. Differences in stage-specific life expectancy were the result of differences in access to care or quality of care. More attention should be given to racial disparities in colorectal cancer management. Although colorectal cancer mortality rates have declined since 1960, these declines have been uneven, 1 – 3 and racial disparities in mortality rates have increased. Factors contributing to increased mortality rates among Blacks include racial differences in risk factors, prevention, detection, and treatment. 4 Blacks receive less colorectal screening, 5 and their cancer is detected at more advanced stages. 6 , 7 Important differences exist in how colorectal cancer is detected, but not necessarily in how it is treated once detected. Significant improvements have occurred in colorectal cancer treatment through time, yet these improvements may not be distributed equally across all racial groups. Previous research has also found Black–White differences in stage-specific colorectal cancer survival rates, suggesting disparities in the management of cancer. 8 – 10 In this article, we assessed whether differences in stage-specific colorectal cancer survival rates reflected racial differences over 4 decades. In doing so, we adjusted for differences in incidence and screening, focusing instead on the management of tumors once they are found. Racial disparities are likely a product of a broad set of social, biological, and environmental factors. By observing changes in stage-specific mortality over time, rather than statically at a cross-sectional moment, we may develop a better understanding of how these factors have contributed to increased racial disparities.
