Availability of Healthcare Resources and Colorectal Cancer Outcomes Among Non-Hispanic White and Non-Hispanic Black Adults

Abstract

This study aims to examine if access to healthcare, measured through the availability of medical resources at the neighborhood level, influences colorectal cancer (CRC) stage, treatment and survival using the Surveillance Epidemiology and Ends Result (SEER) dataset (November 2012), linked with the 2004 Area Resource File. A cross-sectional study was conducted to determine the association between availability of healthcare resources and CRC outcomes among non-Hispanic Black (n = 9162) and non-Hispanic White patients (n = 97,264). CRC patients were identified using the SEER*Stat program, and individual socio-demographic, clinical, and county-level healthcare access variables were obtained for each patient. Among NH-W patients, residence in counties with lower number of oncology hospitals was associated with increased odds of late stage diagnosis (OR 1.09, 95 % CI 1.04-1.14), reduced odds of receiving surgery (OR 0.83, 95 % CI 0.74-0.92) and higher hazard rates (HR 1.09, 95 % CI 1.06-1.12). There were no significant associations among NH-B patients. Increased availability of healthcare resources improves CRC outcomes among NH-W patients. However, future studies are required to better understand healthcare utilization patterns in NH-B neighborhoods, and identify other important dimensions of healthcare access such as affordability, acceptability and accommodation.

Community characteristics and regional variations in sepsis

“…Impoverishment may impact health through access to personal health care providers, quality of care, healthcare literacy and availability of effective medical treatments. 18 We found that counties in Sepsis Cluster or Sepsis Belt regions had larger numbers of medical physicians per 100 000 persons, but lower education and income. Our study delineates that persons living in regions with otherwise higher 'access to care' are still at greater odds for sepsis.…”

“…In the USA, socio-economic status remains an important determinant of health and mortality. 7,41,42 Whereas geographic and socio-economic differences in diseases such as cancer and cardiovascular disease have been extensively researched, 11,18,27,28,[43][44][45] very few studies have attempted to uncover the community characteristics that predict sepsis risk. We found that community poverty was a weak mediator of the association between region and odds of sepsis, and similarly other studies have indicated that neighbourhood poverty and income are associated with bloodstream and bacterial infections.…”

“…We determined community characteristics for this study based on publicly available variables that characterize county-level socio-economic status and healthcare availability, including median household income, percentage of the population completing college, percentage of the population below the poverty line, percentage of population without medical insurance coverage, unemployment rate, percentage of urban population and number of active medical doctors per 100 000 persons. 5,18…”

Availability of healthcare resources and epithelial ovarian cancer stage of diagnosis and mortality among Blacks and Whites

“…[ 11 , 18 ] Prior studies have shown that the availability of healthcare resources has significant influence on health outcomes, including breast and colorectal cancer survival. [ 19 – 21 ] The influence of healthcare availability on health outcomes also appears to vary by race; a higher number of medical personnel and health facilities in US counties was observed not to be significantly associated with reduced late stage presentation and longer survival for Black colorectal cancer patients, but was associated with improved outcomes for White colorectal cancer patients. [ 19 , 21 ] Since Black women are more likely to present with late stage of disease and have higher mortality, despite lower ovarian cancer incidence compared with Whites, [ 22 – 25 ] examining if and how availability of healthcare resources influences ovarian cancer stage and mortality among Blacks and Whites may improve understanding of the causes of persistent racial disparities, while highlighting potential areas for targeted intervention strategies.…”

Lifestyle Factors, Colorectal Tumor Methylation, and Survival Among African Americans and European Americans

“…Compared to EA, AA have greater age-adjusted CRC incidence per 100,000 individuals (44 AA versus 38 EA) and greater age-adjusted CRC mortality per 100,000 individuals (19 AA versus 14 EA) 1 . These disparities might not be fully explained by differences in screening rates or access to care 2 , 3 .…”