BACKGROUND The incidence of early-onset colorectal cancer(EOCRC,<45 years of age at onset)is on the rise among adults,including African Americans(AA).AIM To examine differences between EOCRC and late-onset colorect...BACKGROUND The incidence of early-onset colorectal cancer(EOCRC,<45 years of age at onset)is on the rise among adults,including African Americans(AA).AIM To examine differences between EOCRC and late-onset colorectal cancer(LOCRC)among AA patients and any effect during coronavirus disease(COVID)by comparing data during pre-COVID(2015-2019)and the COVID era(2020-2023).METHODS We conducted a retrospective review of Howard University Hospital records from 2015 to 2023 for colorectal cancer patients that included demographics,clinicals,pathology,and colonoscopy records.A three-year interval analysis was performed to compare post-COVID era(2020-2023)to preceding years to discern temporal trends.RESULTS The study included 138 LOCRC and 13 EOCRC cases of which>80%of patients were AA.Compared to pre-COVID,LOCRC cases increased in number from 55 to 83,and EOCRC cases increased from 6 to 7 during COVID.There was no change in mean age for LOCRC(64.7 years vs 65.3 years)but mean age increased for EOCRC(37.3 years vs 41.5 years).Males predominated in both groups particularly during the pandemic.More than 65%of LOCRC patient colonoscopies were for diagnostic purposes.Gastrointestinal bleeding as a colonoscopy indication and reduced bowel preparation quality were increased during the pandemic.EOCRC patients showed a shift from stage 4(49.2%)to stage 2(30%)and LOCRC patients staging trends changed from stage 4(40%)to stage 3(28.6%).CONCLUSION We report increase in colorectal cancer cases during the COVID-19 era,especially among young AA males.EOCRC and LOCRC patients showed distal location predominance,most commonly in recto-sigmoid region.The decrease in staging or metastasis,which might be due to growing awareness and earlier detection among patients.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)disproportionately affected African Americans(AA)and Hispanics(HSP).AIM To analyze the significant effectors of outcome in African American patient population and make ...BACKGROUND The coronavirus disease 2019(COVID-19)disproportionately affected African Americans(AA)and Hispanics(HSP).AIM To analyze the significant effectors of outcome in African American patient population and make special emphasis on gastrointestinal(GI)symptoms,laboratory values and comorbidities METHODS We retrospectively evaluated the medical records of 386 COVID-19 positive patients admitted at Howard University Hospital between March and May 2020.We assessed the symptoms,including the GI manifestations,comorbidities,and mortality,using logistic regression analysis.RESULTS Of these 386 COVID-19 positive patients,257(63.7%)were AAs,102(25.3%)HSP,and 26(6.45%)Whites.There were 257(63.7%)AA,102(25.3%)HSP,26(6.45%)Whites.The mean age was 55.6 years(SD=18.5).However,the mean age of HSP was the lowest(43.7 years vs 61.2 for Whites vs 60 for AAs).The mortality rate was highest among the AAs(20.6%)and lowest among HSP(6.9%).Patients with shortness of breath(SOB)(OR2=3.64,CI=1.73-7.65)and elevated AST(OR2=8.01,CI=3.79-16.9)elevated Procalcitonin(OR2=8.27,CI=3.95-17.3),AST(OR2=8.01,CI=3.79-16.9),ferritin(OR2=2.69,CI=1.24-5.82),and Lymphopenia(OR2=2.77,CI=1.41-5.45)had a high mortality rate.Cough and fever were common but unrelated to the outcome.Hypertension and diabetes mellitus were the most common comorbidities.Glucocorticoid treatment was associated with higher mortality(OR2=5.40,CI=2.72-10.7).Diarrhea was prevalent(18.8%),and GI symptoms did not affect the outcome.CONCLUSION African Americans in our study had the highest mortality as they consisted of an older population and comorbidities.Age is the most important factor along with SOB in determining the mortality rate.Overall,elevated liver enzymes,ferritin,procalcitonin and C-reactive protein were associated with poor prognosis.GI symptoms did not affect the outcome.Glucocorticoids should be used judiciously,considering the poor outcomes associated with it.Attention should also be paid to monitor liver function during COVID-19,especially in AA and HSP patients with higher disease severity.展开更多
文摘BACKGROUND The incidence of early-onset colorectal cancer(EOCRC,<45 years of age at onset)is on the rise among adults,including African Americans(AA).AIM To examine differences between EOCRC and late-onset colorectal cancer(LOCRC)among AA patients and any effect during coronavirus disease(COVID)by comparing data during pre-COVID(2015-2019)and the COVID era(2020-2023).METHODS We conducted a retrospective review of Howard University Hospital records from 2015 to 2023 for colorectal cancer patients that included demographics,clinicals,pathology,and colonoscopy records.A three-year interval analysis was performed to compare post-COVID era(2020-2023)to preceding years to discern temporal trends.RESULTS The study included 138 LOCRC and 13 EOCRC cases of which>80%of patients were AA.Compared to pre-COVID,LOCRC cases increased in number from 55 to 83,and EOCRC cases increased from 6 to 7 during COVID.There was no change in mean age for LOCRC(64.7 years vs 65.3 years)but mean age increased for EOCRC(37.3 years vs 41.5 years).Males predominated in both groups particularly during the pandemic.More than 65%of LOCRC patient colonoscopies were for diagnostic purposes.Gastrointestinal bleeding as a colonoscopy indication and reduced bowel preparation quality were increased during the pandemic.EOCRC patients showed a shift from stage 4(49.2%)to stage 2(30%)and LOCRC patients staging trends changed from stage 4(40%)to stage 3(28.6%).CONCLUSION We report increase in colorectal cancer cases during the COVID-19 era,especially among young AA males.EOCRC and LOCRC patients showed distal location predominance,most commonly in recto-sigmoid region.The decrease in staging or metastasis,which might be due to growing awareness and earlier detection among patients.
基金the National Institute on Minority Health and Health Disparities of the National Institutes of Health,No.G12MD007597.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)disproportionately affected African Americans(AA)and Hispanics(HSP).AIM To analyze the significant effectors of outcome in African American patient population and make special emphasis on gastrointestinal(GI)symptoms,laboratory values and comorbidities METHODS We retrospectively evaluated the medical records of 386 COVID-19 positive patients admitted at Howard University Hospital between March and May 2020.We assessed the symptoms,including the GI manifestations,comorbidities,and mortality,using logistic regression analysis.RESULTS Of these 386 COVID-19 positive patients,257(63.7%)were AAs,102(25.3%)HSP,and 26(6.45%)Whites.There were 257(63.7%)AA,102(25.3%)HSP,26(6.45%)Whites.The mean age was 55.6 years(SD=18.5).However,the mean age of HSP was the lowest(43.7 years vs 61.2 for Whites vs 60 for AAs).The mortality rate was highest among the AAs(20.6%)and lowest among HSP(6.9%).Patients with shortness of breath(SOB)(OR2=3.64,CI=1.73-7.65)and elevated AST(OR2=8.01,CI=3.79-16.9)elevated Procalcitonin(OR2=8.27,CI=3.95-17.3),AST(OR2=8.01,CI=3.79-16.9),ferritin(OR2=2.69,CI=1.24-5.82),and Lymphopenia(OR2=2.77,CI=1.41-5.45)had a high mortality rate.Cough and fever were common but unrelated to the outcome.Hypertension and diabetes mellitus were the most common comorbidities.Glucocorticoid treatment was associated with higher mortality(OR2=5.40,CI=2.72-10.7).Diarrhea was prevalent(18.8%),and GI symptoms did not affect the outcome.CONCLUSION African Americans in our study had the highest mortality as they consisted of an older population and comorbidities.Age is the most important factor along with SOB in determining the mortality rate.Overall,elevated liver enzymes,ferritin,procalcitonin and C-reactive protein were associated with poor prognosis.GI symptoms did not affect the outcome.Glucocorticoids should be used judiciously,considering the poor outcomes associated with it.Attention should also be paid to monitor liver function during COVID-19,especially in AA and HSP patients with higher disease severity.
