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Race, Neighborhood Characteristics, and Disparities in Chemotherapy for Colorectal Cancer
  1. Yongping Hao1,*,
  2. Hope Landrine2,
  3. Ahmedin Jemal3,
  4. Kevin C Ward4,
  5. A. Rana Bayakly5,
  6. John L Young, Jr.4,
  7. W. Dana Flanders4,
  8. Elizabeth M Ward3
  1. 1 Centers for Public Health Research and Evaluation, Battelle, United States;
  2. 2 Behavior Research Center, American Cancer Society, United States;
  3. 3 Surveillance and Health Policy Research, American Cancer Society, United States;
  4. 4 Department of Epidemiology, Rollins School of Public Health, Emory University, United States;
  5. 5 Georgia Comprehensive Cancer Registry, United States
  1. Correspondence to: Yongping Hao, Battelle, 2987 Clairmont Road NE, Atlanta, 30329, United States; haoy{at}


Background: Studies have found significant race/ethnic and age differences in receipt of adjuvant chemotherapy for stages III colon and II/III rectal cancers. Little is known about the role of neighborhood factors in these disparities.

Methods: The 4,748 Black and White patients from the Georgia Comprehensive Cancer Registry were diagnosed with stages III colon and II/III rectal cancers between 2000 and 2004. Neighborhood poverty, segregation (% Black residents), and rurality were linked to each patient using census tract identifiers. Multilevel analyses explored the role of neighborhood characteristics, and the nested association of patient race within categories of neighborhoods in receipt of chemotherapy.

Results: Odds of receiving chemotherapy for urban and suburban patients were 38% (95% CI: 1.09-1.74) and 53% (95% CI: 1.20-1.94) higher than for rural patients. However, odds of receiving chemotherapy for urban Black patients were 24% (95% CI: 0.62-0.94) lower than for their White counterparts. Receipt of chemotherapy did not significantly differ between Blacks and Whites residing in suburban or rural areas.

Conclusion: Black-White disparities in receipt of chemotherapy among Georgia colorectal cancer patients were confined to urban patients. Disparities in receipt of this treatment for rural patients were found irrespective of patient race. Our findings highlight geographic areas where targeted interventions might be needed.

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