Heterogeneity in the Survival Benefit of Guideline-Concordant Care across Racial and Ethnic Groups with Colorectal Cancer.

Authors

Mehmet Zafer Sabuncuoglu, Ismail Zihni

Published in

Journal of racial and ethnic health disparities. Oct 28, 2026. Epub Oct 28, 2026.

Abstract

Racial/ethnic disparities in colorectal cancer mortality persist in the United States despite treatment advances. We examined racial/ethnic differences in guideline-concordant care (GCC) receipt and cancer-specific mortality, estimated the proportion of the Black-White disparity mediated through GCC, and tested for heterogeneity in the GCC-survival association across groups.
Population-based cohort study using the Surveillance, Epidemiology, and End Results (SEER) Program. Adults with a first primary colorectal adenocarcinoma diagnosed 2010-2017 were included (N = 45,267). GCC was operationalized as a composite score (0-4) per NCCN recommendations. The primary outcome, cancer-specific mortality (CSM), was analyzed using Fine-Gray subdistribution hazard models. Race/ethnicity x GCC interactions were tested by likelihood ratio test; causal mediation decomposed effects into mediated and direct components.
Among 45,267 patients (52% male), CSM occurred in 10,478 (23%) over a median 77 months. GCC receipt differed significantly across groups (all p < 0.001). Non-Hispanic Black patients had higher adjusted CSM than White patients (SHR 1.20, 95% CI 1.11-1.28); Asian/PI patients had lower CSM (SHR 0.86, 95% CI 0.78-0.95). A significant race x GCC interaction was identified (p = 0.0036), with a stronger GCC-CSM association among Black than White patients (interaction HR 0.907, 95% CI 0.847-0.971). GCC differences accounted for only 2.2% (95% CI 0.8-4.5%) of the Black-White disparity.
Racial/ethnic disparities in colorectal cancer mortality were not substantially explained by differences in GCC receipt. A significant race/ethnicity x GCC interaction indicated that Black patients derived greater survival benefit per care component. Equitable care delivery is important but insufficient to eliminate persistent disparities; structural and social determinants must also be addressed.

PMID:
42955181
Bibliographic data and abstract were imported from PubMed on 30 Oct 2026.

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