Racial disparities in cancer stage at diagnosis among older adults with gastrointestinal cancers in the southeastern United States.

Abstract

806 Background: Prior studies have documented racial disparities in survival among older adults with various gastrointestinal (GI) cancers, but mechanisms remain poorly understood. We hypothesized that delayed diagnosis leading to advanced cancer stage at presentation could be a contributing factor to these disparities. Methods: We included adults ≥ 60 years with newly diagnosed GI cancers presenting for initial consultation at University of Alabama at Birmingham from October 2017 to April 2024. Using self-reported race and ethnicity, we stratified patients into Non-Hispanic Whites, Non-Hispanic Black, Hispanics and other category. For this analysis, we limited our cohort to the first two categories. Cancer stage was abstracted from the Electronic Health Record and followed American Joint Commission on Staging (AJCC) 7 th manual. We performed two-sided Pearson’s chi square test to test the association between stage at diagnosis and race. We performed this analysis for the overall cohort as well as for specific GI cancer types. The level of significance was set at p < 0.05. Results: A total of 1714 patients were included; Out of which 74% were non non-Hispanic white and 26% were African American. The median age at presentation was 68 years (interquartile range: 64 - 74), and 42% were females. The most common cancer type was colorectal (28%) followed by pancreatic (26%), hepatobiliary (22%), other GI cancers (14%) and gastroesophageal (10%). Overall, around 45% patients had Stage IV at diagnosis, followed by Stage III (26%), Stage II (17%) and Stage I (11%). We found that as compared to non-Hispanic Whites, non-Hispanic Blacks were more likely to have advanced stage disease, stage III (29% vs 25%) and stage IV (47% vs 45%), this association was statistically significant (Table). Furthermore, this association was most prominent for pancreatic cancers, where non-Hispanic Blacks were more likely to have advanced stage disease, stage III (21% vs 16%), and stage IV (50% vs 47%; p < 0.05). Conclusions: We report that among older adults with GI cancers, African Americans were more likely to have advanced stage at diagnosis compared to non-Hispanic whites, specifically in patients with pancreatic cancer. This finding may contribute to some of the racial disparities observed in survival outcomes in this population. Contingency table showing frequencies (%) of cancer stages for non-Hispanic Whites and African Americans. GI Cancer Stage Non-Hispanic White African American p value Stage I 138 (11%) 51 (11%) <0.05 Stage II 236 (19%) 57 (13%) Stage III 321 (25%) 129 (29%) Stage IV 572 (45%) 210 (47%)