BACKGROUND: Few studies have examined the outcomes for Hispanic men with prostate carcinoma and incorporated socioeconomic factors in association with race/ethnicity in affecting survival, adjusting for factors on cancer stage, grade, comorbidity, and treatment.METHODS: We studied a population‐based cohort of 61,228 men diagnosed with local or regional stage prostate carcinoma at age 65 years or older between 1992 and 1999 in the 11 SEER (Surveillance, Epidemiology, and End Results) areas, identified from the SEER‐Medicare linked data with up to 11 years of followup.RESULTS: Low socioeconomic status was significantly associated with decreasing survival in all men with prostate carcinoma. Those living in the community with the lowest quartile of socioeconomic status were 31% more likely to die than those living in the highest quartile (hazard ratio [HR] of all‐cause mortality: 1.31; 95% confidence interval [CI]: 1.25–1.36) after adjustment for patient age, comorbidity, Gleason score, and treatment. The HR remained almost unchanged after controlling for race/ethnicity (HR: 1.32; 95% CI: 1.26–1.38). Compared with Caucasians, the risk of mortality in African American men was marginally significantly higher (HR: 1.06; 95% CI: 1.01–1.11) after controlling for education, and no longer significant after adjusting for poverty, income, or composite socioeconomic variable; the HR was lower for Hispanic men (HR: 0.80; 95% CI: 0.72–0.89) after adjustment for education and other socioeconomic variables.CONCLUSION: Racial disparity in survival among men with local or regional prostate carcinoma was largely explained by socioeconomic status and other factors. Lower socioeconomic status appeared to be one of the major barriers to achieving comparable outcomes for men with prostate carcinoma. Cancer 2006. © 2006 American Cancer Society.

BACKGROUND.: To the authors' knowledge, few studies have addressed racial disparities in the survival of patients with colon cancer by adequately incorporating treatment and socioeconomic factors in addition to patient and tumor characteristics.METHODS.: The authors studied a nationwide and population‐based, retrospective cohort of 18,492 men and women who were diagnosed with stage II or III colon cancer at age ≥65 years between 1992 and 1999. This cohort was identified from the Surveillance, Epidemiology, and End Results (SEER) cancer registries‐Medicare linked databases and included up to 11 years of follow‐up.RESULTS.: A larger proportion (70%) of African‐American patients with colon cancer fell into the poorest quartiles of socioeconomic status compared with Caucasians (21%). Patients who lived in communities with the lowest socioeconomic level had 19% higher all‐cause mortality compared with patients who lived in communities with the highest socioeconomic status (hazards ratio [HR], 1.19; 95% confidence interval [95% CI], 1.13–1.26; P < .001 for trend). The risk of dying was reduced only slightly after controlling for race/ethnicity (HR, 1.17; 95% CI, 1.10–1.24). Compared with Caucasian patients with colon cancer, African‐American patients were 21% more likely to die after controlling for age, sex, comorbidity scores, tumor stage, and grade (HR, 1.21; 95% CI, 1.12–1.30). After also adjusting for definitive therapy and socioeconomic status, the HR of mortality was only marginally significantly higher in African Americans compared with Caucasians for all‐cause mortality (HR, 1.10; 95% CI, 1.02–1.19) and colon cancer‐specific mortality (HR, 1.16; 95% CI, 1.01–1.33).CONCLUSIONS.: Lower socioeconomic status and lack of definitive treatment were associated strongly with decreased survival in both men and women with colon cancer. Racial disparities in survival were explained substantially by differences in socioeconomic status. Cancer 2007. © 2007 American Cancer Society.

BACKGROUND: This is the first study to use the linked National Longitudinal Mortality Study and Surveillance, Epidemiology, and End Results (SEER) data to determine the effects of individual‐level socioeconomic factors (health insurance, education, income, and poverty status) on racial disparities in receiving treatment and in survival.METHODS: This study included 13,234 cases diagnosed with the 8 most common types of cancer (female breast, colorectal, prostate, lung and bronchus, uterine cervix, ovarian, melanoma, and urinary bladder) at age ≥25 years, identified from the National Longitudinal Mortality Study‐SEER data during 1973 to 2003. Kaplan‐Meier methods and Cox regression models were used for survival analysis.RESULTS: Three‐year all‐cause observed survival for cases diagnosed with local‐stage cancers of the 8 leading tumors combined was ≥82% regardless of race/ethnicity. More favorable survival was associated with higher socioeconomic status. Compared with whites, blacks were less likely to receive first‐course cancer‐directed surgery, perhaps reflecting a less favorable stage distribution at diagnosis. Hazard ratio (HR) for cancer‐specific mortality was significantly higher among blacks compared with whites (HR, 1.2; 95% confidence interval [CI], 1.1‐1.3) after adjusting for age, sex, and tumor stage, but not after further controlling for socioeconomic factors and treatment (HR, 1.0; 95% CI, 0.9‐1.1). HRs for all‐cause mortality among patients with breast cancer and for cancer‐specific mortality in patients with prostate cancer were significantly higher for blacks compared with whites after adjusting for socioeconomic factors, treatment, and patient and tumor characteristics.CONCLUSIONS: Favorable survival was associated with higher socioeconomic status. Racial disparities in survival persisted after adjusting for individual‐level socioeconomic factors and treatment for patients with breast and prostate cancer. Cancer 2011. © 2011 American Cancer Society.

To examine racial/ethnic disparities in mortality and survival in a large nationwide and population-based cohort of women with breast cancer after simultaneously controlling for differences in comorbidity, treatment, and socioeconomic status. A cohort of 35,029 women with stage I-IIIA breast cancer at age > or = 65 from 1992 to 1999 was identified from the surveillance, epidemiology, and end results-medicare linked databases with up to 11 years of follow-up. Cox proportional hazard regression analysis was performed to determine the risk of all-cause and breast cancer-specific mortality. African-American women with breast cancer were more likely to live in the poorest quartiles of socioeconomic status at the census tract level than whites (73.7% versus 20.7%, P < 0.001). Those living in communities with the lowest socioeconomic status were 11% more likely to die than those in the highest (hazard ratio, 1.10; 95% confidence interval, 1.04-1.16). The risk of dying changed slightly after controlling for race/ethnicity (1.11; 1.05-1.18). Compared with white women with breast cancer, crude hazard ratios of all-cause and breast cancer-specific mortality were 1.35 (1.27-1.45) and 1.83 (1.56-2.16) for African-Americans. After adjusting for treatment and socioeconomic status, hazard ratio of all-cause mortality was no longer significant in African-Americans (1.02; 0.84-1.10), whereas the risk of breast cancer-specific mortality was marginally higher in African-Americans (1.21; 1.01-1.46). Racial disparities in overall survival between African-American and white women with breast cancer were not present after controlling for treatment and socioeconomic status. Efforts to eliminate these barriers have important public health implications for reducing disparities in health outcomes.

BACKGROUND.: There is a lack of research on ethnic disparities in survival among patients with non‐Hodgkin lymphoma (NHL), although these disparities have been documented for patients with many other tumors.METHODS.: A retrospective cohort of 13,321 patients diagnosed with incident NHL at age ≥65 years from 1992 to 1999 were identified from the Surveillance, Epidemiology, and End Results (SEER)‐Medicare linked database with 11 years of follow‐up. Of these patients, 11,868 were Caucasians, 533 were African Americans, and 920 were other ethnicities. A time‐to‐event Cox regression model was used to examine the relative risk of all‐cause and disease‐specific mortality.RESULTS.: A larger proportion (72.2%) of African Americans were in the poorest quartile of socioeconomic status as measured by the poverty level compared with 21.8% of Caucasians, and 43.2% of African Americans received chemotherapy compared with 52.4% of Caucasians (P < .01). Hazard ratio of all‐cause and NHL‐specific mortality increased significantly with age, advanced stage, higher comorbidity scores, and poorer socioeconomic status. Patients receiving either chemotherapy or radiotherapy or both were significantly less likely to die. After taking into account differences in treatment, comorbidity, and socioeconomic status, there was no statistically significant difference in the risk of all‐cause (hazard ratio, 0.97; 95% confidence interval, 0.88‐1.08) and disease‐specific mortality (hazard ratio, 1.07; 95% confidence interval, 0.92‐1.25) between African Americans and Caucasians.CONCLUSIONS.: The risk of mortality in patients with NHL was associated with socioeconomic status and was reduced in patients receiving chemotherapy. No significant differences in the risk of mortality were observed between African Americans and Caucasians after controlling for factors such as treatment and socioeconomic status. Cancer 2008. © 2008 American Cancer Society.