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The Compounding Effect of Colon Cancer Disparities in America

In August, acclaimed actor Chadwick Boseman tragically passed away at age 43 after a four-year battle with colon cancer. Boseman played the role of Black Panther as well as several African American historical icons, some of which he filmed while quietly undergoing cancer treatment.

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Colorectal cancer, which is characterized by the uncontrolled growth of abnormal cells in the colon or rectum, accounts for 8.2% of all new cancer cases and is the second leading cause of cancer death in the United States. Colon cancer also disproportionately affects communities of color and economically marginalized populations.

As part of U.S. News’ ongoing series on health equity, U.S. News data analysts took a closer look at disparities in colon cancer and found stark differences in who was diagnosed, at what stage, and how they fared. Black, Hispanic and low socioeconomic status patients were less likely to be screened, more likely to be admitted for an emergent procedure, and had an increased risk of mortality and shorter overall survival time compared with wealthier, white patients. This analysis, combined with an investigation of peer-reviewed literature and interviews with clinical experts, revealed the pivotal role that preventive care has in driving some of these disparities.

Factors that contribute to cancer disparities across racial and socioeconomic lines are complex and interrelated. Socioeconomic status here refers to individuals who are simultaneously enrolled in both Medicare and Medicaid. In 2018 there were 12.2 million dual eligible beneficiaries, 60% of whom have multiple chronic conditions, according to the Centers for Medicare & Medicaid Services.

Many dual eligible patients also experience a higher burden of social risk factors, such as poverty and limited access to community resources, and need ongoing long-term care services and support. The racial breakdown of Medicare beneficiaries by dual eligibility status in Table 1 shows that both Black and Hispanic patients are overly represented in the dual eligible portion of the population, when compared with the breakdown of all eligible beneficiaries. For example, despite making up only 11% of all Medicare beneficiaries, Black patients are 20% of dual eligible beneficiaries. This trend is reversed for white patients, who comprise 80% of all Medicare beneficiaries but just 62% of dual eligible beneficiaries. These statistics indicate that Black and Hispanic Medicare beneficiaries are more likely to be dual eligible than their white counterparts.

Among Medicare patients with colon cancer who underwent surgery, Black and Hispanic patients experienced longer hospital stays, and they were more likely to be readmitted to the hospital within 30 days of the procedure compared with their white counterparts, after accounting for comorbidities. While Hispanic patients had an increased risk of mortality within 30 days of the procedure, there was a reduced risk of death among Black patients, when compared with white patients. Figure 1 demonstrates the risk of these outcomes by race and socioeconomic status. Within each race and ethnic category, we see that dual eligible patients in fact consistently experience a higher risk of poor outcomes after undergoing colon cancer surgery.