Table 4.
Racial Disparities Studies Which Include Socioeconomic Status as Part of Multivariable Model.
| Years of Study, Reference | Population | Outcome | Race Groupings | HR, 95% CI | Disparity |
|---|---|---|---|---|---|
| 1988-1992, Simon and Severson (13) | DMA1 SEER2
N=10,502 |
Overall Survival – Local, Regional and Distant Stage - Breast | Age < 50 | Multivariate RR | Blacks had worse overall survival particularly among younger women after adjustment for clinical factors and SES-based on census tract. |
| Black | 1.68 (1.27-2.23) | ||||
| White | Ref | ||||
| Age 51 + | |||||
| Black | 1.33 (1.13-1.56) | ||||
| White | Ref | ||||
| 1988-1992, Yan et al. (15) | DMA-SEER N-9,078 |
Overall and disease-specific survival-Colo-rectal | Overall Survival | Multivariate HR | No Black-White differences in overall or disease specific survival after adjustment for clinical and SES-based on census tract. |
| Black | 1.0 (0.92-1.09) | ||||
| White | Ref | ||||
| Disease specific Survival | |||||
| Black | 1.06 (0.94-1.19) | ||||
| White | Ref | ||||
| 1988-1992 Movva et al. (48) |
DMA-SEER N=1,036 |
Overall Survival for stage I-IV - cervical cancer | Overall Survival | Multivariate HR | No Black-White differences in overall survival after adjustment for clinical factors and SES based on census tract. |
| Black | 1.12 (0.89-1.42) | ||||
| White | Ref | ||||
| 1994-1997, Du and Simon (18) | KCC3
N=588 |
Overall Survival and disease free survival -Stage I-III -Breast | Disease Free Survival | Multivariate HR | No Black-White differences in disease free or overall survival after adjustment for clinical factors and co-morbidities (insurance as proxy for SES but not included in the multivariable model) |
| Black | 1.38 (0.85-2.26) | ||||
| White | Ref | ||||
| Overall Survival | |||||
| Black | 1.06 (0.64-1.79) | ||||
| White | Ref | ||||
| 1996-2005, Roseland et al. (17) | HFHS4 N=2,387 | Overall Survival – Stage I-III-Breast | Overall Survival | Multivariate HR after adjustment for SES | No Black-White overall survival differences after adjustment for SES based on disparity index |
| Black | 0.97 (0.8-1.19) | ||||
| White | Ref | ||||
| 1996-2005, Roseland et al. (49) | HFHS N=542 |
Overall Survival ER/PR-, Stage I-III-Breast | Overall Survival | Multivariate HR after adjustment for SES | No Black-White overall survival differences only after adjustment for SES based on disparity index. After adjustment for clinical factors and treatment Blacks still had worse outcome. |
| Black | 1.26 (0.84-1.87) | ||||
| White | Ref | ||||
| 1988-1992, Schwartz et al. (52) | DMA - SEER N=45,056 | Regional + Distant vs. Local Stage at diagnosis-Breast, prostate, lung, colorectal and cervical. | Breast CA | Adjusted OR | Black race independently predicted advanced stage after adjustment for SES based on census tract for breast and prostate. No differences for lung, colorectal or cervical |
| Black | 1.30 (1.17-1.46) | ||||
| White | Ref | ||||
| Prostate CA | |||||
| Black | 1.51 (1.35-1.70) | ||||
| White | Ref | ||||
| 12/2002-1/2013 Lantz et al. (14) |
DMA + Los Angeles SEER N=1,700 |
Stage 0 + I vs. Stage II + III - Breast |
Adjusted OR | No Black-White differences in stage at diagnosis after adjustment for clinical factors, treatment, diagnostic method and SES-(only study with SES based on individual survey) | |
| Black | 0.79 (0.57-1.1) | ||||
| White | Ref | ||||
| 2000-2009, Holowatyj et al. (16). | SEER-18 N=28,145 |
Disease specific survival (age 20-49)-Colon and Rectal | Colon | Adjusted HR | Black-White differences in disease specific survival for young onset colorectal cancer after adjustment for clinical and treatment factors, and SES based on county-level poverty. |
| Black | 1.35 (1.26-1.45) | ||||
| White | Ref | ||||
| Rectal | |||||
| Black | 1.51 (1.37-1.68) | ||||
| White | Ref | ||||
| 1988-1992, Schwartz et al. (27) | DMA-SEER N=8,679 |
Influence of co-morbidity and SES on overall and disease specific survival for local and regional stage-prostate | Overall Survival | Adjusted HR | No overall survival differences for Black and White men with local or regional stage disease, however disease specific survival differences for men with local stage, after adjustment for treatment and SES-based on census tract. |
| Local | |||||
| Black | 1.03 (0.96-1.11) | ||||
| White | Ref | ||||
| Regional | |||||
| Black | 0.90 (0.73-1.13) | ||||
| White | Ref | ||||
| Disease Specific | |||||
| Local | |||||
| Black | 1.35 (1.17-1.65) | ||||
| White | Ref | ||||
| Regional | |||||
| Black | 0.83 (0.57-1.20) | ||||
| White | Ref | ||||
| 2002-2007 Schwartz et al. (34) |
DMA-SEER: N=951 |
Overall survival -r renal cell carcinoma | OS: | Adjusted HR | No survival differences after adjustment for clinical, treatment factors, co-morbidities and SES based on deprivation index. |
| Black | 0.93 (0.65-1.35) | ||||
| White | Ref | ||||
| <65y at diagnosis | |||||
| Black | 1.14 (0.71-1.85) | ||||
| White | Ref | ||||
| Tumor ≤4cm: | |||||
| Black | 1.15 (0.67-1.98) | ||||
| White | Ref |
1DMA, Detroit Metropolitan Area.
2SEER, Surveillance, Epidemiology and End Results.
3KCC, Karmanos Cancer Center.
4HFHS, Henry Ford Health System.