Race, Age, Gender, and Insurance Status: A Comparative Analysis of Access to and Quality of Gastrointestinal Cancer Care

Salehi, Omid; Vega, Eduardo; Lathan, Christopher S.; James, Daria; Kozyreva, Olga; Alarcon, Sylvia V.; Kutlu, Onur; Herrick, Beth; Conrad, Claudius

doi:10.1007/s11605-021-05038-6

Cited by 10 publications

(4 citation statements)

References 38 publications

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“…In both time periods in the present study, non‐Hispanic Black patients uniformly experienced lower odds of undergoing resection compared to their White counterparts. This has been demonstrated in a number of prior studies, and unfortunately this disparity does not appear to have been mitigated by passage of the ACA 4,7,22,23 . Continued study of the causes of this disparity, including the relative contributions of specific social determinants of health, will be important in the future especially if effective strategies to lessen this disparity are to be developed.…”

Section: Discussionmentioning

confidence: 98%

“…This has been demonstrated in a number of prior studies, and unfortunately this disparity does not appear to have been mitigated by passage of the ACA. 4,7,22,23 Continued study of the causes of this disparity, including the relative contributions of specific social determinants of health, will be important in the future especially if effective strategies to lessen this disparity are to be developed. Medicaid and other government insurance had no significant association.…”

Section: Receipt Of Multimodality Therapymentioning

confidence: 99%

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Differential effects of the Affordable Care Act on the stage at presentation and receipt of treatment for pancreatic adenocarcinoma

Hao

Mitsakos

Popowicz

et al. 2022

Journal of Surgical Oncology

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Background and Objectives For pancreatic ductal adenocarcinoma (PDAC) which lacks a recommended screening modality, the benefit of the Affordable Care Act (ACA) may not be an earlier diagnosis, but rather improved rates of treatment. The objective of this study was to examine change in the stage of PDAC presentation and treatment disparities following the ACA. Methods A retrospective cohort study of patients with primary PDAC identified in the 2004–2017 National Cancer Database was divided into pre‐ and post‐ACA, for which the primary outcomes of a stage of presentation, receipt of surgical resection, and systemic therapy (termed multimodality) (Stage I–II), and receipt of systemic therapy (Stage III–IV) were compared by multivariable analysis. Results 228,015 patients were included. Odds of presenting with Stage I–II PDAC were significantly higher in 2011–2017 versus 2004–2010 (odds ratio 1.44, 95% confidence interval 1.40–1.47). Black patients with early‐stage disease had a lower likelihood of multimodality therapy and those with advanced disease were less likely to receive systemic therapy, before and after the ACA. Uninsured patients were less likely to receive any therapy compared with insured patients; this disparity increased in the post‐ACA period. Conclusions An earlier presentation of PDAC increased following the ACA. However, racial, insurance, and socioeconomic treatment disparities persist.

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Section: Discussionmentioning

confidence: 98%

Section: Receipt Of Multimodality Therapymentioning

confidence: 99%

Differential effects of the Affordable Care Act on the stage at presentation and receipt of treatment for pancreatic adenocarcinoma

Hao

Mitsakos

Popowicz

et al. 2022

Journal of Surgical Oncology

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“…45 It was possible that this disparity was actually representative of the disproportionate access to surgical care experienced by patients of racial and ethnic minorities. 46 , 47 In addition, it is important to note that SVI was calculated at a census-tract level and therefore was not necessarily reflective of individual patient-level SDH.…”

Section: Discussionmentioning

confidence: 99%

Social Vulnerability Subtheme Analysis Improves Perioperative Risk Stratification in Hepatopancreatic Surgery

Labiner

Hyer

Cloyd

et al. 2022

Journal of Gastrointestinal Surgery

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Background There has been increased interest in understanding how social determinants of health (SDH) may affect care both in the medical and surgical setting. We sought to define the impact of various aspects of social vulnerability on the ability of patients to achieve a “textbook outcome” (TO) following hepatopancreatic surgery. Methods Medicare beneficiaries who underwent hepatopancreatic resection between 2013 and 2017 were identified using the Medicare database. Social vulnerability was defined using the Centers for Disease Control Social Vulnerability Index (SVI), which is comprised of four subthemes: socioeconomic (SE), household composition and disability (HCD), minority status and language (MSL), and housing type and transportation (HTT). TO was defined as the composite endpoint: absence of 90-day mortality or readmission, absence of an extended length of stay (LOS), and no complications during the index admission. Cluster analysis was used to identify vulnerability cohorts, and multivariable logistic regression was utilized to assess the impact of these SVI subthemes on the likelihood to achieve a textbook outcome. Results Among 37,707 Medicare beneficiaries, 64.9% ( n = 24,462) of patients underwent pancreatic resection while 35.1% ( n = 13,245) underwent hepatic resection. Median patient age was 72 years (IQR: 68–77), just over one-half were male (51.9%; n = 19,558), and the median CCI was 3 (IQR: 2–8). Cluster analysis revealed five distinct SVI profiles with wide variability in the distribution of SVI subthemes, ranging from 15 (profile 1 IQR: 7–26) to 83 (profile 5 IQR: 66–93). The five profiles were grouped into 3 categories based on median composite SVI: “low vulnerability” (profile 1), “average vulnerability” (profiles 2 and 3), or “high vulnerability” (profiles 4 and 5). The rate of TO ranged from 44.6% in profile 5 ( n = 4022) to 49.2% in profile 1 ( n = 4836). Multivariable analyses comparing patients categorized into the two average SVI profiles revealed that despite having similar composite SVI scores, the risk of adverse postoperative outcomes was not similar. Specifically, patients from profile 5 had lower odds of achieving a TO (OR 0.89, 95%CI: 0.83–0.95) and higher odds of 90-day mortality (OR 1.29, 95%CI: 1.15–1.44) versus patients in profile 4. Conclusion Distinct profiles of SVI subtheme characteristics were independently associated with postoperative outcomes among Medicare beneficiaries undergoing HP surgery, even among patients with similar overall composite SVI scores. Supplementary Information The online version contains supplementary material available at 10.1007/s11605-022-05245-9.

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“…[1][2][3][4][5] Among individuals who used Medicare Hospice Benefit-the largest source of hospice payment-in 2018, only 8.2% of them were African-Americans (as opposed to 82% being non-Hispanic Whites), while they made up 10.3% of the Medicare beneficiaries in the same year (as opposed to 75% being non-Hispanic Whites). 6,7 Many contributing factors to the disparities encompass various socioeconomic [8][9][10] and cultural factors, [11][12][13][14][15][16] such as lack of insurance, lower income, mistrust in healthcare system, and spiritual/religious beliefs among African-Americans. In addition, lack of hospice awareness has also been identified as one of the barriers to African-Americans' use of hospice care.…”

Section: Disparity Of Hospice Awareness and Hospice Use Among African...mentioning

confidence: 99%

Awareness of Hospice Care Among Rural African-Americans: Findings From Social Determinants of Health Framework

Noh

Lee

et al. 2021

Am J Hosp Palliat Care

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Background: Despite the need for hospice care as our society ages, adults in the U.S.’s southern rural region have limited awareness of hospice care. Objective: This study aims to assess the rate of awareness of hospice care among rural residents living in Alabama’s Black Belt region and examine social determinants of health (SDH) associated with the awareness. Methods: A cross-sectional survey was conducted among a convenience sample living in Alabama’s Black Belt region (N = 179, age = 18-91). Participants’ awareness of hospice care, demographic characteristics (ie, age and gender), and SDH (ie, financial resources strain, food insecurity, education and health literacy, social isolation, and interpersonal safety) were assessed. Lastly, a binary logistic regression was used to examine the association between SDH and hospice awareness among participants while controlling for demographic characteristics. Results: The majority of participants had heard of hospice care (n = 150, 82.1%), and older participants (50 years old or older) were more likely to report having heard of hospice care ( OR = 7.35, P < 0.05). Participants reporting worries about stable housing (OR = 0.05, P < 0.05) and higher social isolation were less likely to have heard of hospice care ( OR = 0.53, P < 0.05), while participants with higher health literacy had a higher likelihood to have heard of it ( OR = 2.60, P < 0.01). Conclusions: Our study is the first study assessing the status of hospice awareness among residents of Alabama’s Black Belt region. This study highlighted that factors including age and certain SDH (ie, housing status, health literacy, and social isolation) might be considered in the intervention to improve hospice awareness.

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Race, Age, Gender, and Insurance Status: A Comparative Analysis of Access to and Quality of Gastrointestinal Cancer Care

Cited by 10 publications

References 38 publications

Differential effects of the Affordable Care Act on the stage at presentation and receipt of treatment for pancreatic adenocarcinoma

Differential effects of the Affordable Care Act on the stage at presentation and receipt of treatment for pancreatic adenocarcinoma

Social Vulnerability Subtheme Analysis Improves Perioperative Risk Stratification in Hepatopancreatic Surgery

Awareness of Hospice Care Among Rural African-Americans: Findings From Social Determinants of Health Framework

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