Racial differences in colorectal cancer incidence and mortality in the women's health initiative

Michael S. Simon, Cynthia A. Thomson, Erin Pettijohn, Ikuko Kato, Rebecca J. Rodabough, Dorothy Lane, F. Allan Hubbell, Mary Jo O'Sullivan, Lucille Adams-Campbell, Charles P. Mouton, Judith Abrams, Rowan T. Chlebowski

Research output: Contribution to journalArticle

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Abstract

Background: Colorectal cancer (CRC) incidence and mortality rates are higher in African-Americans as compared with other racial/ethnic groups. The women's health initiative (WHI) study sample was used to determine whether differences in CRC risk factors explain racial/ethnic differences in incidence and mortality. Methods: The WHI is a longitudinal study of postmenopausal women recruited from 40 centers. Baseline questionnaires were used to collect sociodemographic and health status information. All CRC diagnoses were centrally adjudicated. Cox regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for invasive CRC by race/ethnicity. Results: The study sample included 131,481 (83.7%) White, 14,323 (9.1%) African-American, 6,362 (4.1%) Hispanic, 694 (0.4%) Native American and 4,148 (2.6%) Asian/Pacific Islanders. After a mean follow-up of 10.8 years (SD 2.9), CRC incidence was the highest in African-Americans (annualized rate = 0.14%), followed by Whites and Native Americans (0.12% each), Asian/Pacific Islanders (0.10%), and Hispanics (0.08%). After adjustment for age and trial assignment, Hispanics had a lower risk compared with Whites, HR 0.73 (95% CI: 0.54-0.97) (P = 0.03), and African-Americans had a marginally greater risk, HR 1.16 (95% CI: 0.99-1.34), P = 0.06. Multivariable adjustment attenuated the difference in incidence between African-Americans and Whites (HR 0.99, 95% CI: 0.82-1.20), while strengthening the lower HR for Hispanics (HR 0.68, 95% CI: 0.48-0.97). Conclusions: African-American/White differences in CRC risk are likely due to sociodemographic/cultural factors other than race. Impact: A number of modifiable exposures could be a focus for reducing CRC risk in African-Americans.

Original languageEnglish
Pages (from-to)1368-1378
Number of pages11
JournalCancer Epidemiology Biomarkers and Prevention
Volume20
Issue number7
DOIs
StatePublished - Jul 1 2011
Externally publishedYes

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Women's Health
African Americans
Colorectal Neoplasms
Mortality
Hispanic Americans
Incidence
Confidence Intervals
North American Indians
Proportional Hazards Models
Ethnic Groups
Health Status
Longitudinal Studies
Odds Ratio

ASJC Scopus subject areas

  • Epidemiology
  • Oncology

Cite this

Simon, M. S., Thomson, C. A., Pettijohn, E., Kato, I., Rodabough, R. J., Lane, D., ... Chlebowski, R. T. (2011). Racial differences in colorectal cancer incidence and mortality in the women's health initiative. Cancer Epidemiology Biomarkers and Prevention, 20(7), 1368-1378. https://doi.org/10.1158/1055-9965.EPI-11-0027

Racial differences in colorectal cancer incidence and mortality in the women's health initiative. / Simon, Michael S.; Thomson, Cynthia A.; Pettijohn, Erin; Kato, Ikuko; Rodabough, Rebecca J.; Lane, Dorothy; Hubbell, F. Allan; O'Sullivan, Mary Jo; Adams-Campbell, Lucille; Mouton, Charles P.; Abrams, Judith; Chlebowski, Rowan T.

In: Cancer Epidemiology Biomarkers and Prevention, Vol. 20, No. 7, 01.07.2011, p. 1368-1378.

Research output: Contribution to journalArticle

Simon, MS, Thomson, CA, Pettijohn, E, Kato, I, Rodabough, RJ, Lane, D, Hubbell, FA, O'Sullivan, MJ, Adams-Campbell, L, Mouton, CP, Abrams, J & Chlebowski, RT 2011, 'Racial differences in colorectal cancer incidence and mortality in the women's health initiative', Cancer Epidemiology Biomarkers and Prevention, vol. 20, no. 7, pp. 1368-1378. https://doi.org/10.1158/1055-9965.EPI-11-0027
Simon, Michael S. ; Thomson, Cynthia A. ; Pettijohn, Erin ; Kato, Ikuko ; Rodabough, Rebecca J. ; Lane, Dorothy ; Hubbell, F. Allan ; O'Sullivan, Mary Jo ; Adams-Campbell, Lucille ; Mouton, Charles P. ; Abrams, Judith ; Chlebowski, Rowan T. / Racial differences in colorectal cancer incidence and mortality in the women's health initiative. In: Cancer Epidemiology Biomarkers and Prevention. 2011 ; Vol. 20, No. 7. pp. 1368-1378.
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abstract = "Background: Colorectal cancer (CRC) incidence and mortality rates are higher in African-Americans as compared with other racial/ethnic groups. The women's health initiative (WHI) study sample was used to determine whether differences in CRC risk factors explain racial/ethnic differences in incidence and mortality. Methods: The WHI is a longitudinal study of postmenopausal women recruited from 40 centers. Baseline questionnaires were used to collect sociodemographic and health status information. All CRC diagnoses were centrally adjudicated. Cox regression models were used to compute hazard ratios (HRs) and 95{\%} confidence intervals (CIs) for invasive CRC by race/ethnicity. Results: The study sample included 131,481 (83.7{\%}) White, 14,323 (9.1{\%}) African-American, 6,362 (4.1{\%}) Hispanic, 694 (0.4{\%}) Native American and 4,148 (2.6{\%}) Asian/Pacific Islanders. After a mean follow-up of 10.8 years (SD 2.9), CRC incidence was the highest in African-Americans (annualized rate = 0.14{\%}), followed by Whites and Native Americans (0.12{\%} each), Asian/Pacific Islanders (0.10{\%}), and Hispanics (0.08{\%}). After adjustment for age and trial assignment, Hispanics had a lower risk compared with Whites, HR 0.73 (95{\%} CI: 0.54-0.97) (P = 0.03), and African-Americans had a marginally greater risk, HR 1.16 (95{\%} CI: 0.99-1.34), P = 0.06. Multivariable adjustment attenuated the difference in incidence between African-Americans and Whites (HR 0.99, 95{\%} CI: 0.82-1.20), while strengthening the lower HR for Hispanics (HR 0.68, 95{\%} CI: 0.48-0.97). Conclusions: African-American/White differences in CRC risk are likely due to sociodemographic/cultural factors other than race. Impact: A number of modifiable exposures could be a focus for reducing CRC risk in African-Americans.",
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AU - Simon, Michael S.

AU - Thomson, Cynthia A.

AU - Pettijohn, Erin

AU - Kato, Ikuko

AU - Rodabough, Rebecca J.

AU - Lane, Dorothy

AU - Hubbell, F. Allan

AU - O'Sullivan, Mary Jo

AU - Adams-Campbell, Lucille

AU - Mouton, Charles P.

AU - Abrams, Judith

AU - Chlebowski, Rowan T.

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N2 - Background: Colorectal cancer (CRC) incidence and mortality rates are higher in African-Americans as compared with other racial/ethnic groups. The women's health initiative (WHI) study sample was used to determine whether differences in CRC risk factors explain racial/ethnic differences in incidence and mortality. Methods: The WHI is a longitudinal study of postmenopausal women recruited from 40 centers. Baseline questionnaires were used to collect sociodemographic and health status information. All CRC diagnoses were centrally adjudicated. Cox regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for invasive CRC by race/ethnicity. Results: The study sample included 131,481 (83.7%) White, 14,323 (9.1%) African-American, 6,362 (4.1%) Hispanic, 694 (0.4%) Native American and 4,148 (2.6%) Asian/Pacific Islanders. After a mean follow-up of 10.8 years (SD 2.9), CRC incidence was the highest in African-Americans (annualized rate = 0.14%), followed by Whites and Native Americans (0.12% each), Asian/Pacific Islanders (0.10%), and Hispanics (0.08%). After adjustment for age and trial assignment, Hispanics had a lower risk compared with Whites, HR 0.73 (95% CI: 0.54-0.97) (P = 0.03), and African-Americans had a marginally greater risk, HR 1.16 (95% CI: 0.99-1.34), P = 0.06. Multivariable adjustment attenuated the difference in incidence between African-Americans and Whites (HR 0.99, 95% CI: 0.82-1.20), while strengthening the lower HR for Hispanics (HR 0.68, 95% CI: 0.48-0.97). Conclusions: African-American/White differences in CRC risk are likely due to sociodemographic/cultural factors other than race. Impact: A number of modifiable exposures could be a focus for reducing CRC risk in African-Americans.

AB - Background: Colorectal cancer (CRC) incidence and mortality rates are higher in African-Americans as compared with other racial/ethnic groups. The women's health initiative (WHI) study sample was used to determine whether differences in CRC risk factors explain racial/ethnic differences in incidence and mortality. Methods: The WHI is a longitudinal study of postmenopausal women recruited from 40 centers. Baseline questionnaires were used to collect sociodemographic and health status information. All CRC diagnoses were centrally adjudicated. Cox regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for invasive CRC by race/ethnicity. Results: The study sample included 131,481 (83.7%) White, 14,323 (9.1%) African-American, 6,362 (4.1%) Hispanic, 694 (0.4%) Native American and 4,148 (2.6%) Asian/Pacific Islanders. After a mean follow-up of 10.8 years (SD 2.9), CRC incidence was the highest in African-Americans (annualized rate = 0.14%), followed by Whites and Native Americans (0.12% each), Asian/Pacific Islanders (0.10%), and Hispanics (0.08%). After adjustment for age and trial assignment, Hispanics had a lower risk compared with Whites, HR 0.73 (95% CI: 0.54-0.97) (P = 0.03), and African-Americans had a marginally greater risk, HR 1.16 (95% CI: 0.99-1.34), P = 0.06. Multivariable adjustment attenuated the difference in incidence between African-Americans and Whites (HR 0.99, 95% CI: 0.82-1.20), while strengthening the lower HR for Hispanics (HR 0.68, 95% CI: 0.48-0.97). Conclusions: African-American/White differences in CRC risk are likely due to sociodemographic/cultural factors other than race. Impact: A number of modifiable exposures could be a focus for reducing CRC risk in African-Americans.

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