Socioeconomic Factors Impact Colon Cancer Outcomes in Diverse Patient Populations

Lee, Wendy; Nelson, Rebecca A.; Mailey, Brian; Duldulao, Marjun P.; García-Aguilar, Julio; Kim, Joseph

doi:10.1007/s11605-011-1809-y

Cited by 43 publications

(28 citation statements)

References 23 publications

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“…Racial disparities in cancer mortalities have long been ascribed to differences in socioeconomic status, which is a measure of education, poverty status, occupation, access to healthcare, and preventative care, all of which correspond to access to treatment and the quality of treatment [17]. Higher socioeconomic status in non-Hispanic white might be associated with increased utilization of health care services, better neighborhood resources, greater health education and awareness, thereby improving overall health status and prognosis [17, 18]. On the contrary, lower income and education has been traditionally associated with reduced access to sufficient healthcare and treatment, resulting in poorer outcome [17-19].…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Gastrointestinal Cancers-Related Mortality in the US Population

Jinjuvadia

Liangpunsakul

2012

Dig Dis Sci

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Background Racial difference in cancer-related mortality has been described in epidemiological studies and evidence points towards higher mortalities in the minorities. To determine the magnitude of racial disparities and sex differences in GI cancer-related mortalities in the US population, we analyzed the data using the third National Health and Nutrition Examination Survey (NHANES III) and related mortality data files. Methods NHANES III and its related public linked mortality files were used for this study. Our study cohort included subjects who were ≥18 years and were part of the longitudinal mortality follow-up database. The overall GI cancers related mortality was calculated using combined mortality from malignant neoplasm of esophagus, stomach, colon, liver and pancreas. The evaluation of independent predictors of overall GI cancer-related mortality and of each individual GI cancer was carried out using the Cox proportional hazards model. Results A total of 13,221 individuals were included in the analyses with the average person year follow-up of 13.9 years. During the follow-up period, 4,146 subjects died. Of these, 199 were from GI-related cancers. Non-Hispanic black (NHB) had significantly higher overall GI-cancer related mortality compared to non-Hispanic white (NHW, adjusted hazard ratio, aHR: 2.31, 95 % CI 1.57–3.38, p < 0.001). Subgroup analyses by sex demonstrated higher mortality from gastric, colorectal and primary liver cancer related mortality in NHB men compared to NHW men. Esophageal and pancreatic cancer mortalities were higher in NHB women compared to NHW women. Conclusion Overall GI cancer-related mortality is significantly higher among NHB compared to NHW in the US population.

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Section: Discussionmentioning

confidence: 99%

Racial Disparities in Gastrointestinal Cancers-Related Mortality in the US Population

Jinjuvadia

Liangpunsakul

2012

Dig Dis Sci

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“…Colorectal cancer outcomes have been shown to vary by hospital, socioeconomic status of patients, and individual patient preferences or comorbidities. [10][11][12][13][14] Disentangling the effect of these factors related to access and use of care for colorectal cancer has been challenging, given the considerable overlap among patient ethnicity, socioeconomic status, and insurance status.…”

Section: Introductionmentioning

confidence: 99%

Impact of Health Insurance Expansion on the Treatment of Colorectal Cancer

Loehrer

Song

Haynes

et al. 2016

JCO

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Colorectal cancer is the third most common cancer and the third leading cause of cancer deaths in the United States. Lack of insurance coverage has been associated with more advanced disease at presentation, more emergent admissions at time of colectomy, and lower survival relative to privately insured patients. The 2006 Massachusetts health care reform serves as a unique natural experiment to assess the impact of insurance expansion on colorectal cancer care. MethodsWe used the Hospital Cost and Utilization Project State Inpatient Databases to identify patients with colorectal cancer with government-subsidized or self-pay (GSSP) or private insurance admitted to a hospital between 2001 and 2011 in Massachusetts (n = 17,499) and three control states (n = 144,253). Difference-in-differences models assessed the impact of the 2006 Massachusetts coverage expansion on resection of colorectal cancer, controlling for confounding factors and secular trends. ResultsBefore the 2006 Massachusetts reform, government-subsidized or self-pay patients had significantly lower rates of resection for colorectal cancer compared with privately insured patients in both Massachusetts and the control states. The Massachusetts insurance expansion was associated with a 44% increased rate of resection (rate ratio = 1.44; 95% CI, 1.23 to 1.68; P , .001), a 6.21 percentage point decreased probability of emergent admission (95% CI, 211.88 to 20.54; P = .032), and an 8.13 percentage point increased probability of an elective admission (95% CI, 1.34 to 14.91; P = .019) compared with the control states. ConclusionThe 2006 Massachusetts health care reform, a model for the Affordable Care Act, was associated with increased rates of resection and decreased probability of emergent resection for colorectal cancer. Our findings suggest that insurance expansion may help improve access to care for patients with colorectal cancer.

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“…It is clear that SES, geographic, and insurance factors are also associated with outcome disparity [4] [8] [12] [13]. Accounting for these potential confounding factors unveils a more complex picture [4] [7] [8] [11] [12] [14] [15]. For example, in an equal access system, the Veteran's Administration, outcomes disparities across racial lines are significantly diminished [12] [14].…”

Section: Introductionmentioning

confidence: 99%

Insurance Payer Status and Race Explains Much of the Variability in Colorectal Cancer Survival

Fitzgerald¹,

Lea²,

Atluri³

et al. 2014

JCT

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Socioeconomic Factors Impact Colon Cancer Outcomes in Diverse Patient Populations

Cited by 43 publications

References 23 publications

Racial Disparities in Gastrointestinal Cancers-Related Mortality in the US Population

Racial Disparities in Gastrointestinal Cancers-Related Mortality in the US Population

Impact of Health Insurance Expansion on the Treatment of Colorectal Cancer

Insurance Payer Status and Race Explains Much of the Variability in Colorectal Cancer Survival

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