Demographic Disparities in Late-Stage Diagnosis of Breast and Colorectal Cancers Across the USA

BACKGROUND We determined whether there were disparities in the likelihood of being diagnosed at a late stage for breast cancer (BC) or colorectal cancer (CRC) in each of 40 states, using the recently available US Cancer Statistics (USCS) database. METHODS We extracted 981,457 BC cases and 558,568 CRC cases diagnosed in 2004-2009. Separate multilevel regressions were run for each state and each cancer type. Models included person and area-level covariates and were identically specified across states. The disparities foci were race or ethnicity (white, African-American, Hispanic, Asian, all other), gender, and age (<40, 40-49, 50-64, 65-74, and 75+). Using whites, males, and the oldest age group as reference groups, we noted the statistically significant disparities coefficients (p value ≤0.05) and translated the findings via a set of maps of states in the USA. RESULTS National disparity estimates were not consistent with disparities identified in the states. Some states had estimates consistent with the national average, while others did not. Patterns of disparities across states were different for each covariate and mapped separately. CONCLUSION National disparity estimates may mask what is true at the more local, state level because national estimates can confound the effects of race with place. Cancer control efforts are local and require locally relevant information to assess needs. Findings from the period 2004-2009 establish valuable benchmarks against which to assess changes following national health reform implemented in 2010. The USCS database is a valuable new resource that will facilitate future disparities research.