Race/ethnicity and socio-economic differences in colorectal cancer surgery outcomes: analysis of the nationwide inpatient sample

Abstract

BackgroundThe purpose of this study was to examine racial and socio-economic differences in the receipt of laparoscopic or open surgery among patients with colorectal cancer, and to determine if racial and socio-economic differences exist in post-surgical complications, in-hospital mortality and hospital length of stay among patients who received surgery.MethodsWe conducted a cross-sectional analysis of hospitalized patients with a primary diagnosis of colorectal cancer between 2007 and 2011 using data from Nationwide Inpatient Sample. ICD-9 codes were used to capture primary diagnosis, surgical procedures, and health outcomes during hospitalization. We used logistic regression analysis to determine racial and socio-economic predictors of surgery type, post-surgical complications and mortality, and linear regression analysis to assess hospital length of stay.ResultsA total of 122,631 patients were admitted with a primary diagnosis of malignant colorectal cancer between 2007 and 2011. Of these, 17,327 (14.13 %) had laparoscopic surgery, 70,328 (57.35 %) received open surgery, while 34976 (28.52 %) did not receive any surgery. Black (36 %) and Hispanic (34 %) patients were more likely to receive no surgery compared with Whites (27 %) patients. However, among patients that received any surgery, there were no racial differences in which surgery was received (laparoscopic versus open, p = 0.2122), although socio-economic differences remained, with patients from lower residential income areas significantly less likely to receive laparoscopic surgery compared with patients from higher residential income areas (OR: 0.74, 95 % CI: 0.70-0.78). Among patients who received any surgery, Black patients (OR = 1.07, 95 % CI: 1.01-1.13), and patients with Medicare (OR = 1.16, 95 % CI: 1.11-1.22) and Medicaid (OR = 1.15, 95 % CI: 1.07-1.25) insurance experienced significantly higher post-surgical complications, in-hospital mortality (Black OR = 1.18, 95 % CI: 1.00-1.39), and longer hospital stay (Black β = 1.33, 95 % CI: 1.16-1.50) compared with White patients or patients with private insurance.ConclusionRacial and socio-economic differences were observed in the receipt of surgery and surgical outcomes among hospitalized patients with malignant colorectal cancer in the US.

Systematic review of the influence of socioeconomic deprivation on mortality after colorectal surgery

“…This review therefore included 59 articles published between 1993 and 2016, reporting on a total of 2 698 403 patients ( Table S2, supporting information). These studies included data collected between 1976 and 2014 from eight countries.…”

Treatment of stage I‐III rectal cancer: Who is refusing surgery?

“…Older age has been associated with a higher likelihood of not receiving standard cancer treatment 24 . Black race has been associated with substandard rectal cancer treatment, with prior studies showing that Black patients have lower rates of undergoing surgery or receiving adjuvant chemotherapy compared to White patients 25,26 . Moreover, prior work has shown that uninsured cancer patients or those with Medicaid compared to private insurance are less likely to receive standard surgical treatment and have higher mortality 27,28 .…”

Mapping hot spots of breast cancer mortality in the United States: place matters for Blacks and Hispanics

“…Several factors likely contribute to racial differences in breast cancer mortality and in particular, the observed geographic clustering. However, studies suggest that the most significant causes relate to lack of adequate and timely screening necessary for early detection, and lack of access to adjuvant chemotherapy and/or surgical interventions [2, 6, 44-55]. Fedewa et al (2011) reported that NH-Blacks were 25% to 106% more likely to have delayed breast cancer chemotherapy after 30-, 60-, and 90-days following breast cancer diagnosis [48].…”