Predictors of Delayed-Stage Colorectal Cancer: Are We Neglecting Critical Demographic Information?

PurposeWe sought to distinguish roles of demographic variables and bowel segments as predictors of delayed versus early stage colorectal cancer in California.MethodsDemographic and anatomic variables for 66,806 colorectal cancers were extracted from the California Cancer Registry for 2004–2008 and analyzed using logistic regression as delayed versus early stage.ResultsOdds ratios (OR) for binary stage categories comparing age <40 (OR=2.58; 95% CI=2.26–2.94), 40–49 (1.71; 95%=1.60–1.83) and 75+ (1.05; 1.02–1.09) relative to 50-74 years were computed. Compared with non-Hispanic whites, ORs for stage categories were: 1.05; 0.99–1.13 (non-Hispanic blacks), 1.08; 1.02–1.13 (Hispanics), and 1.05; 1.00–1.10 (Asian/others). Females had higher odds of delayed diagnosis (1.09; 1.06–1.13) than males. Descending ORs were measured for successively lower to highest socioeconomic status (SES) quintiles (OR 4:5=1.08; 1.03–1.14, OR 3:5=1.13; 1.08–1.19, OR 2:5=1.18; 1.12– 1.24, and OR 1:5=1.21; 1.14–1.28).ConclusionsYounger and older than age 50-74; females; Hispanic ethnicity; bowel segment contrasts (right/left, proximal/distal, cecum plus appendix/distal), and lower SES were independent predictors of delayed diagnosis. Low SES was the most robust predictor of delayed diagnosis, independent of other covariates. Approximately 77% of delayed diagnoses were in non-Hispanic whites and Asian/others. These findings illustrate the value of a community SES index for targeting egalitarian colorectal cancer screening.