5 - THE INTERSECTION OF RACE AND RURALITY AND ITS EFFECT ON COLORECTAL CANCER SURVIVAL

Objectives: Outcomes in colorectal cancer treatment are historically worse in African-Americans and residents of rural areas. Purported reasons include factors such as systemic racism, poverty, lack of access to care, and social determinants of health. We sought to determine whether outcomes worsened when race and rural residence intersected.

Methods: The National Cancer Database was queried for individuals with stage II–III colorectal cancer (2004–2018). Variables included age at diagnosis, sex, race, Charlson–Deyo score, insurance status, stage, and facility type. To examine the intersectionality of race/rurality on outcomes, race (Caucasian/African-American) and rurality (based on zip code) were combined into a single variable. The main outcome of interest was five-year survival. Cox regression analysis was performed to determine variables independently associated with survival.

Results: Of 501,259 patients, 361,974 were urban-Caucasian,78,056 were rural-Caucasian, 55,034 were urban-African American, and 6,195 were rural-African American. Overall five-year mortality rate was 31.6%. Univariate Kaplan–Meier survival analysis demonstrated race-rurality was associated with overall survival (p < 0.001), with Urban-Caucasian having the highest (47.9 months) and Rural-African American having the lowest mean survival (46.7 months). Multivariable analysis found that Rural-Caucasian (HR: 1.05; 95% confidence interval: (1.04–1.07), Urban-African American (1.16 [1.16-1.18]), Rural-African American (1.26 [1.20-1.32]) all had increased mortality when compared to Urban-Caucasian individuals(p < 0.001).

Conclusion: Although rural Caucasians fared worse than urban Caucasians, African-Americans fared worst of all, with the poorest outcomes observed in African-Americans in rural areas. This suggests that both African-American race and rurality negatively affect survival, and act synergistically to further worsen outcomes.