Abstract
The relative disease burden among American Blacks for the common gastrointestinal (GI) cancers, i.e. esophagus, stomach, pancreas, liver, and colorectal, was compared with that among American Whites and with NCI research funding per death relative to other common cancers.
Methods: Data on incidence, mortality, demographics, and years of lost life (YLL) for the most common cancers was retrieved from the Surveillance, Epidemiology, and End Results (SEER) database 2005-2009. Additional data from the National Health and Nutrition Examination Survey (NHANES III) and the Medicare payment database were also utilized. Data on funding by type of cancer was retrieved from the NCI site, http://fundedresearch.cancer.gov. This study used SEER definitions of race and did not include Asian Americans and did not consider Hispanic ethnicity or immigrant status, although the rates of many GI malignancies in these populations is known to be high.
Results: For all five GI cancers, the incidence rates for both males and females were greater for Blacks compared with Whites. The ratio of Black to White age-adjusted rates for males were 1.94 for stomach cancer, 1.62 for liver and intra-hepatic bile duct cancers, 1.26 for pancreas cancers, 1.23 for colorectal cancers, and 1.04 for esophageal cancers. For females, the ratios were 2.04 for stomach, 1.45 for esophagus, 1.36 for liver, 1.36 for pancreas, and 1.22 for colorectal. For all sites, across all organ systems, the ratio of cancer incidence between Blacks and Whites was 1.15 for men and 0.94 for women. Mortality rates followed a similar pattern.
Research funding per cancer death varied greatly by cancer site. For example, funding per year was $1,102 per stomach cancer death vs. $12,785 per melanoma death and $15,057 per breast cancer death. The GI cancer with the highest research funding per death was colorectal, which received $3,170. Funding per death for each of the five GI cancers was below the median level of funding per death for all cancers. Funding relative to YLL, disability adjusted life year (DALY), and financial costs of lost productivity were also below the median for each of the five cancers. Research funding relative to Medicare costs was above the median for liver cancer and below the median for the other four.
Discussion: Gastrointestinal cancers impose a greater burden of disease on Black than on White Americans. In terms of incidence, mortality, YLL, DALY, lost productivity, and cost of treatment, research into these cancers is under-funded compared with cancers elsewhere in the body. The reasons for differential funding of research into various diseases are complex. However, the relative underfunding of research into gastrointestinal cancers is having a disparate impact on the health of Black Americans.
Citation Format: James R. Hillard. Gastrointestinal cancers disproportionately affect black Americans and are disproportionately underfunded by NCI. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C69.
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