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Effect Modification of the Association Between Race and Stage at Colorectal Cancer Diagnosis by Socioeconomic Status
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2019
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Source: J Public Health Manag Pract. 25(Suppl 5 TRIBAL EPIDEMIOLOGY CENTERS ADVANCING PUBLIC HEALTH IN INDIAN COUNTRY FOR OVER 20 YEARS):S29-S35
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Alternative Title:J Public Health Manag Pract
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Description:Objectives
To compare risks of distant-stage colorectal cancer (CRC) diagnosis between Whites and American Indian/Alaska Natives (AI/AN) and to explore effect modification by area-based socioeconomic status (SES).
Design
Retrospective cohort study using data from the Oklahoma Central Cancer Registry.
Setting
Oklahoma.
Participants
White and AI/AN cases of CRC diagnosed in Oklahoma between 2001 and 2008 (N= 8 438). A sub-analysis was performed on the cohort of those ages 50 and older (N=7 728).
Main Outcome Measure
Risk of distant-stage CRC diagnosis stratified by SES score.
Results
Race and SES were independently associated with distant-stage diagnosis. In SES-stratified analyses, AI/ANs in the two lowest SES groups experienced increased risks in the overall cohort and among those 50 and older. In multivariable models, risks remained significant among those 50 and older in the lowest SES groups (Adjusted RR SES score of 2: 1.31, 95% CI: 1.06, 1.63 and Adjusted RR SES score of 1: 1.21, 95% CI: 1.01, 1.44).
Conclusion
SES is an effect modifier in the association between race/ethnicity and stage at CRC diagnosis. Disparities in stage at CRC diagnosis exist between AI/ANs and whites with lower estimated SES. Efforts are needed to increase CRC screening among lower SES AI/ANs.
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Pubmed ID:31348188
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Pubmed Central ID:PMC7043013
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