ORIGINAL ARTICLE
Year : 2017  |  Volume : 16  |  Issue : 1  |  Page : 3

The impact of gender, race, socioeconomic status, and treatment on outcomes in esophageal cancer: A population-based analysis


1 Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, CA, USA
2 Department of Epidemiology and Genetic Epidemiology Research Institute, University of California, Irvine, CA, USA
3 The Angeles Clinic and Research Institute; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
4 Department of Medicine, Division of Hematology/Oncology; Department of Epidemiology and Genetic Epidemiology Research Institute, University of California, Irvine, CA, USA

Correspondence Address:
Jason A Zell
Department of Medicine, Division of Hematology and Oncology, University of California, Irvine, 101 The City Drive South, Building 56. Orange, CA 92868
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcar.JCar_4_17

Background: African Americans and Hispanics are reported to have higher mortality from esophageal cancer (EC) than Caucasians. In this study, we analyzed the independent effects of race, gender, treatment, and socioeconomic status (SES) on overall survival (OS). Methods: Data for all EC cases between 2004 and 2010 with follow-up through 2012 were obtained from the California Cancer Registry. We conducted descriptive analyses of clinical variables and survival analyses by Kaplan–Meier and Cox proportional hazards methods. Results: African Americans and Hispanics were more likely to be in the lower SES strata and less likely to receive surgery than Caucasians in this cohort. The proportion of patients receiving chemotherapy and radiotherapy was similar across different racial/ethnic groups. After adjustment for stage, grade, histology, treatments, and SES in multivariate analyses, the mortality risk in African Americans (hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.85–1.07) and Hispanics (HR 0.96, 95% CI 0.89–1.07) did not differ from Caucasians (HR = 1.00, referent), with histology, SES, and surgery largely accounting for unadjusted OS differences. We also observed that African American men had higher adjusted risk of death relative to Caucasian men (HR 1.24, 95% CI 1.07–1.42), but this effect was not observed for African American women compared to Caucasian women (HR 1.12, 95% CI 0.94–1.35). Conclusions: Race is not an independent risk factor for OS in our population-based analysis of EC cases. Rather, observed differences in OS by race/ethnicity result from differences in cancer histology, SES, surgery, and gender. Our findings support further health disparities research for this disease.


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