The Role of Stage at Diagnosis in XXXX Black-White Survival Disparities: A Counterfactual Causal Inference Approach.

@entity5 @entity1 @entity14 @entity1349
BACKGROUND: To date, a counterfactual framework has not been used to study determinants of social inequalities in @entity5 . Considering the case of @entity14 , for which racial/ethnic differences in stage at diagnosis and survival are well documented, we quantify the extent to which black versus white survival disparities would be reduced had disparities in stage at diagnosis been eliminated in a large @entity1 population. METHODS: We obtained data on @entity14 @entity1 (diagnosed between 1992 and 2005 and followed until 2010) from US-SEER (Surveillance, Epidemiology, and End Results) @entity5 registries. We employed a counterfactual approach to estimate the mean survival time up to the 60th month since diagnosis for black @entity14 @entity1 had black-white disparities in stage at diagnosis been eliminated. RESULTS: Black @entity1 survive approximately 4.0 [confidence interval (CI), 4.6-3.2] months less than white @entity1 within five years since diagnosis. Had disparities in stage at diagnosis been eliminated, survival disparities decrease to 2.6 (CI, 3.4-1.7) months, an approximately 35% reduction. For @entity1 diagnosed after the age of 65 years, disparities would be halved, while reduction of approximately 30% is estimated for younger @entity1 . @entity1349 would be reduced by approximately 44% for @entity1 and approximately 26% for @entity1 . CONCLUSIONS: Employing a counterfactual approach and allowing for heterogeneities in black-white disparities across @entity1 ' characteristics, we give robust evidence that elimination of disparities in stage at diagnosis contributes to a substantial reduction in survival disparities in @entity14 . IMPACT: We provide the first evidence in the SEER population that elimination of inequities in stage at diagnosis might lead to larger reductions in survival disparities among elderly and @entity1 . Cancer Epidemiol Biomarkers Prev; 25(1); 1-7.   2015 AACR.
