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The study of racial/ethnic inequalities in health is important to reduce theuneven burden of disease. In the case of colorectal cancer (CRC), disparitiesin survival among non-Hispanic Whites and Blacks are well documented, andmechanisms leading to these disparities need to be studied formally. It hasalso been established that body mass index (BMI) is a risk factor fordeveloping CRC, and recent literature shows BMI at diagnosis of CRC isassociated with survival. Since BMI varies by racial/ethnic group, a questionthat arises is whether disparities in BMI is partially responsible for observedracial/ethnic disparities in CRC survival. This paper presents new methodologyto quantify the impact of the hypothetical intervention that matches the BMIdistribution in the Black population to a potentially complex distributionalform observed in the White population on racial/ethnic disparities in survival.We perform a simulation that shows our proposed Bayesian density regressionapproach performs as well as or better than current methodology allowing for ashift in the mean of the distribution only, and that standard practice ofcategorizing BMI leads to large biases. When applied to motivating data fromthe Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium, ourapproach suggests the proposed intervention is potentially beneficial forelderly and low income Black patients, yet harmful for young and high incomeBlack populations.

The Role of Body Mass Index at Diagnosis on Black-White Disparities in Colorectal Cancer Survival: A Density Regression Mediation Approach