Racial Clustering and Access to Colorectal Surgeons, Gastroenterologists, and Radiation Oncologists by African Americans and Asian Americans in the United States

Abstract

African Americans with colorectal cancer have higher mortality than non-African Americans with colorectal cancer despite the overall declines in the incidence and mortality due to this disease among the entire US population.¹ The explanation for this discrepancy is poorly understood. Previous attempts made to examine the interaction and contribution of characteristics of socioeconomic status, health insurance, and physician provider (hereafter referred to as “provider”) have largely been inconclusive.^2-4 A wide racial disparity exists in early stage diagnosis of colorectal cancer.⁵ Residential factors have previously been implicated as affecting both access and outcome.⁶ Racial clustering and segregation have been shown to be significant predictors of infant mortality. The greater the extent of segregation, the higher the infant mortality.⁷ Less has been reported about the specific effects of residential segregation on colon cancer mortality, but the possibility of differential access, as determined by variations in geographic availability of subspecialty providers, has been implicated as a possible cause of delay in screening. In-deed, African Americans living in highly segregated areas have a higher incidence and mortality of gastrointestinal tract cancers.⁶