Ethnic distribution of colorectal carcinoma at a large urban New York Hospital

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Introduction: Poorer outcomes are usually found in patients with colorectal carcinoma treated in public sector hospitals. Presumably, these results are related to inconsistent screening and a later stage of malignancy at presentation. Long-term survival from colorectal carcinoma is directly related to the tumor stage at presentation. An analysis of patients with colorectal carcinoma at a large public hospital was undertaken.
 Methods: All patients treated for colorectal cancer between 2000 and 2006 at Bellevue Hospital Center were reviewed. Ethnicity was documented in the medical record, and was determined by the individual.
 Results: There were 240 patients in the series. The majority were classified as Asian (81, 33.8%) or Hispanic (80, 33.3%), with fewer African-American (37, 15.4%), Caucasian (37, 15.4%), or Other (5, 2.1%).
 Caucasian (18, 48.7%) and African-American (13, 35.1%) patients were more likely to present with stage IV disease, compared to Asian (23, 28.4%) or Hispanic (25, 31.3%) patients.
 Stage III disease was more common in Asian (27, 33.3%) and Hispanic (25, 31.3%) patients, with fewer presenting with Stage I (Asian (16, 19.8%) and Hispanic (13, 16.3%)) or Stage II disease (Asian (13, 16.1%) and Hispanic (14, 17.5%)).
 More men (143, 59.6%) than women (97, 40.4%) were found in our series. For all ethnic groups, more women presented with Stage I (21.7% vs 14.9%) or Stage II (19.6% vs 16.1%), and fewer women presented with Stage III (24.7% vs 31.5%) or Stage IV disease (29.9% vs 35.7%).
 Conclusion: Our data demonstrates a change in the demographic pattern typically associated with a public hospital. The majority of our patients (67.1%) are Asian or Hispanic, which reflects the changing ethnic diversity of New York City.
 Our data also demonstrate an ethnic disparity in patients presenting with colorectal carcinoma. For all ethnic groups, the majority presented with stage III or IV disease. However, Asian and Hispanic patients consistently presented earlier than Caucasian and African-American patients. The reasons for this disparity are unknown, but may include family support structure, financial resources, education level and health insurance. Public hospitals must continue to improve patient education and health care access so more patients can be diagnosed and treated at an earlier stage.