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Background <p>To evaluate the associations between race/ethnicity and cancer-specific and all-cause mortality and to explore potential mediating factors.</p> Methods <p>We identified patients diagnosed with lung (22,866), colorectal (13,382), melanoma (6894), prostate (22,922), and breast (133,366) cancers between 2010 and 2019 from the Texas Cancer Registry. Differences in mortality risk among non-Hispanic Blacks, Asian American/Native Hawaiian/Pacific Islanders (AANHPI), and Hispanics compared to non-Hispanic Whites were estimated using Cox proportional hazard and restricted mean survival time analyses. Mediation analysis was conducted to quantify the contributions of socioeconomic, clinicopathologic, and treatment-related factors to observed mortality differences.</p> Results <p>Racial/ethnic disparities in survival were observed across all cancers, with the smallest disparity for lung cancer and the largest for melanoma and breast cancer. In age-and-sex-adjusted models, Blacks had higher mortality risks for all cancers observed. Hispanics showed higher mortality risks for non-small cell lung cancer, melanoma, and breast cancer, while AANHPIs had lower mortality risks for lung and breast cancer. After adjusting for demographic, clinical, and treatment factors, Blacks still had significantly higher mortality risks for melanoma (HR = 1.63, 95% CI = 1.49–1.70) and breast cancer (HR = 1.19, 95% CI = 1.09–1.30). Socioeconomic and clinicopathologic factors were major mediators of racial/ethnic disparities, accounting for 56.71% of the difference in melanoma mortality and 54.10% in breast cancer mortality between Blacks and Whites.</p> Conclusions <p>Racial/ethnic disparities in cancer outcomes persist, particularly for melanoma and breast cancer among Black patients. Interventions promoting equity in cancer outcomes should be tailored by cancer type and take a multidisciplinary approach, integrating both social and biological factors to address disparities effectively.</p>

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Racial and Ethnic Disparities in Cancer Mortality and Mediating Effects of Sociodemographic, Clinicopathologic, and Treatment Factors

  • 期刊论文

  • 发表日期：

    2025年9月25日

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  • Olajumoke A. Olateju,
  • Hassan E. Arekemase,
  • Hemalkumar B. Mehta,
  • Ahizechukwu C. Eke,
  • Chan Shen,
  • J. Douglas Thornton

摘要

Background

To evaluate the associations between race/ethnicity and cancer-specific and all-cause mortality and to explore potential mediating factors.

Methods

We identified patients diagnosed with lung (22,866), colorectal (13,382), melanoma (6894), prostate (22,922), and breast (133,366) cancers between 2010 and 2019 from the Texas Cancer Registry. Differences in mortality risk among non-Hispanic Blacks, Asian American/Native Hawaiian/Pacific Islanders (AANHPI), and Hispanics compared to non-Hispanic Whites were estimated using Cox proportional hazard and restricted mean survival time analyses. Mediation analysis was conducted to quantify the contributions of socioeconomic, clinicopathologic, and treatment-related factors to observed mortality differences.

Results

Racial/ethnic disparities in survival were observed across all cancers, with the smallest disparity for lung cancer and the largest for melanoma and breast cancer. In age-and-sex-adjusted models, Blacks had higher mortality risks for all cancers observed. Hispanics showed higher mortality risks for non-small cell lung cancer, melanoma, and breast cancer, while AANHPIs had lower mortality risks for lung and breast cancer. After adjusting for demographic, clinical, and treatment factors, Blacks still had significantly higher mortality risks for melanoma (HR = 1.63, 95% CI = 1.49–1.70) and breast cancer (HR = 1.19, 95% CI = 1.09–1.30). Socioeconomic and clinicopathologic factors were major mediators of racial/ethnic disparities, accounting for 56.71% of the difference in melanoma mortality and 54.10% in breast cancer mortality between Blacks and Whites.

Conclusions

Racial/ethnic disparities in cancer outcomes persist, particularly for melanoma and breast cancer among Black patients. Interventions promoting equity in cancer outcomes should be tailored by cancer type and take a multidisciplinary approach, integrating both social and biological factors to address disparities effectively.