Health care disparities in colorectal and esophageal cancer.

BACKGROUND: We aimed to identify differences in disparities among patients with a cancer in which screening is widely recommended (colorectal cancer [CRC]) and one in which it is not (esophageal cancer).

METHODS: A retrospective analysis was performed using 2004-2015 data from the National Cancer Database. Multivariable generalized logistic regression was used to identify potential differences in the effect of disparities in stage at diagnosis.

RESULTS: A total of 96,524 esophageal cancer patients and 361,187 CRC patients were included. Black patients, longer travel distances, and lower educational attainment were only associated with increased odds of stage IV CRC. While both Medicaid and uninsured patients were more likely to be diagnosed with stage IV esophageal and CRC, the effect was larger among CRC patients. From 2004 to 2015, the rates of stage IV esophageal cancer decreased from 42.0% to 38.2%, while the rates of stage IV CRC increased from 36.9% to 40.8% (p < 0.0001).

CONCLUSIONS: Disparities are more pronounced in CRC, compared to esophageal cancer. Equity in access to screening and cancer care should be prioritized.