Highlighting cancer healthcare disparities experienced by African Americans in the U.S. from the National Healthcare Quality and Disparities Report (NHQR-DR)

Background: Cancer deaths have declined in the United States, but African Americans account for the greatest burden for most of the common types of cancer.

Methods: 15 cancer measures from the NHQR-DR database were organized into 3 categories: Prevention, Treatment and Outcome. The measures were assessed comparing Blacks to Whites. Baseline year (2000-2002) and most current year (2008-2010) are compared to assess disparity trends.  Significant differences between Blacks and Whites (reference) for most recent year and trends over time (3 plus years) require a minimum relative difference of >10% between the two groups, and statistical significance with p-value <0.05 (two-tailed tests). Trends are analyzed for Blacks only and assessed using weighted least squares regression of change where average annual rate of change is at least 1 percent per year and statistically significant p-value <0.05. 

Findings:

Overall findings show that 60% of the measures (9/15) showed Blacks had worse cancer rates compared to Whites, such as diagnosed advanced stage breast cancer and deaths for all cancers.

Over time, 13% (2/15) of the cancer healthcare quality measures, such as prostate cancer deaths, show a narrowing in disparities between Blacks and Whites; and 7% (1/15) are worsening, like diagnosed advanced stage breast cancer. Blacks improved for 67% of the cancer healthcare quality measures (10/15); such as diagnosed advanced stage cervical cancer and all cancer deaths.

Prevention:

2000-2008:  Blacks were less likely than Whites to report that they received a colonoscopy, sigmoidoscopy or proctoscopy.

2000-2010:  No differences between Black and White women who received a mammography in the last 2 years; and those who received a pap smear in the last 3 years.

 Treatment:

2000-2009:  Black women were more likely to have diagnosed advanced stage breast cancer and advanced stage cervical cancer; and Blacks overall had higher rates of diagnosed advanced stage colorectal cancer; when compared to Whites.

Outcome:

2000-2010: Breast cancer deaths were worse for Black women; and overall, Blacks had higher colorectal cancer death rates and had higher cancer death rates for all cancers when compared to Whites.

Conclusions: Large gaps still exist in the quality of care received by Blacks. Focused policies and research that can identify specific ways to improve the areas of concern highlighted in this assessment can greatly improve the quality of life and health of Blacks.