Racial/ethnic disparities in colorectal cancer treatment utilization and phase-specific costs, 2000-2014

Tramontano, Angela C.; Chen, Yufan; Watson, Tina R.; Eckel, Andrew; Hur, Chin; Kong, Chung Yin

doi:10.1371/journal.pone.0231599

Cited by 46 publications

(37 citation statements)

References 61 publications

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“…Further, these differences persisted when comparing racial cohorts with the same health insurance status, suggesting that adequate insurance coverage is not associated with mitigated racial disparities in cancer care delivery. Across all stages of diagnosis, Black patients are less likely to receive treatment for colorectal cancer [15]. Prior studies of the Surveillance Epidemiology and End Results (SEER) registry have demonstrated that Black patients have lower odds of undergoing surgery for colorectal cancer [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

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Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States

et al. 2021

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Background Both health insurance status and race independently impact colon cancer (CC) care delivery and outcomes. The relative importance of these factors in explaining racial and insurance disparities is less clear, however. This study aimed to determine the association and interaction of race and insurance with CC treatment disparities. Study setting Retrospective cohort review of a prospective hospital-based database. Methods and findings In this cross-sectional study, patients diagnosed with stage I to III CC in the United States were identified from the National Cancer Database (NCDB; 2006 to 2016). Multivariable regression with generalized estimating equations (GEEs) were performed to evaluate the association of insurance and race/ethnicity with odds of receipt of surgery (stage I to III) and adjuvant chemotherapy (stage III), with an additional 2-way interaction term to evaluate for effect modification. Confounders included sex, age, median income, rurality, comorbidity, and nodes and margin status for the model for chemotherapy. Of 353,998 patients included, 73.8% (n = 261,349) were non-Hispanic White (NHW) and 11.7% (n = 41,511) were non-Hispanic Black (NHB). NHB patients were less likely to undergo resection [odds ratio (OR) 0.66, 95% confidence interval [CI] 0.61 to 0.72, p < 0.001] or to receive adjuvant chemotherapy [OR 0.83, 95% CI 0.78 to 0.87, p < 0.001] compared to NHW patients. NHB patients with private or Medicare insurance were less likely to undergo resection [OR 0.76, 95% CI 0.63 to 0.91, p = 0.004 (private insurance); OR 0.59, 95% CI 0.53 to 0.66, p < 0.001 (Medicare)] and to receive adjuvant chemotherapy [0.77, 95% CI 0.68 to 0.87, p < 0.001 (private insurance); OR 0.86, 95% CI 0.80 to 0.91, p < 0.001 (Medicare)] compared to similarly insured NHW patients. Although Hispanic patients with private and Medicare insurance were also less likely to undergo surgical resection, this was not the case with adjuvant chemotherapy. This study is mainly limited by the retrospective nature and by the variables provided in the dataset; granular details such as continuity or disruption of insurance coverage or specific chemotherapy agents or dosing cannot be assessed within NCDB. Conclusions This study suggests that racial disparities in receipt of treatment for CC persist even among patients with similar health insurance coverage and that different disparities exist for different racial/ethnic groups. Changes in health policy must therefore recognize that provision of insurance alone may not eliminate cancer treatment racial disparities.

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Section: Discussionmentioning

confidence: 99%

“…Across all stages of diagnosis, Black patients are less likely to receive treatment for colorectal cancer [ 15 ]. Prior studies of the Surveillance Epidemiology and End Results (SEER) registry have demonstrated that Black patients have lower odds of undergoing surgery for colorectal cancer [ 15 – 17 ].…”

Section: Discussionmentioning

confidence: 99%

Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States

et al. 2021

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“…Prior work has shown that underutilization of medical resources in Black patients in the United States is a significant societal problem. 46 , 47 Further studies are needed to determine if explicit or implicit racism plays a role in this finding.…”

Section: Discussionmentioning

confidence: 99%

An Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients

Taghavi

Maher

Goldberg

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND Prehospital procedures (PHP) by emergency medical services (EMS) are performed regularly in penetrating trauma patients despite previous studies demonstrating no benefit. We sought to examine the influence of PHPs on outcomes in penetrating trauma patients in urban locations where transport to trauma center is not prolonged. We hypothesized that patients without PHPs would have better outcomes than those undergoing PHP. METHODS This was an Eastern Association for the Surgery of Trauma–sponsored, multicenter, prospective, observational trial of adults (18+ years) with penetrating trauma to the torso and/or proximal extremity presenting at 25 urban trauma centers. The impact of PHPs and transport mechanism on in-hospital mortality were examined. RESULTS Of 2,284 patients included, 1,386 (60.7%) underwent PHP. The patients were primarily Black (n = 1,527, 66.9%) males (n = 1,986, 87.5%) injured by gunshot wound (n = 1,510, 66.0%) with 34.1% (n = 726) having New Injury Severity Score of ≥16. A total of 1,427 patients (62.5%) were transported by Advanced Life Support EMS, 17.2% (n = 392) by private vehicle, 13.7% (n = 312) by police, and 6.7% (n = 153) by Basic Life Support EMS. Of the PHP patients, 69.1% received PHP on scene, 59.9% received PHP in route, and 29.0% received PHP both on scene and in route. Initial scene vitals differed between groups, but initial emergency department vitals did not. Receipt of ≥1 PHP increased mortality odds (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.01–1.83; p = 0.04). Logistic regression showed increased mortality with each PHP, whether on scene or during transport. Subset analysis of specific PHP revealed that intubation (OR, 10.76; 95% CI, 4.02–28.78; p < 0.001), C-spine immobilization (OR, 5.80; 95% CI, 1.85–18.26; p < 0.01), and pleural decompression (OR, 3.70; 95% CI, 1.33–10.28; p = 0.01) had the highest odds of mortality after adjusting for multiple variables. CONCLUSION Prehospital procedures in penetrating trauma patients impart no survival advantage and may be harmful in urban settings, even when performed during transport. Therefore, PHP should be forgone in lieu of immediate transport to improve patient outcomes. LEVEL OF EVIDENCE Prognostic, level III.

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“…Ultimately, 18 studies were analyzed. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] The total number of patients included 89,214 black patients and 646,990 white patients, ranging from 513 to 11,111 and 2,047 to 190,688, respectively. In all articles, a retrospective analysis of patients was presented including the outcome of surgical utilization.…”

Section: Resultsmentioning

confidence: 99%

Colorectal Cancer Disparities Across the Continuum of Cancer Care: A Systematic Review and Meta-Analysis

Syvyk

Wirtalla

Kelz

et al. 2021

Preprint

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IMPORTANCE Colorectal Cancer (CRC) disparities continue to mostly impact vulnerable populations. Across the CRC continuum, most focus has been attributed to interventions in prevention, detection, and diagnosis. Varying surgical outcomes has emerged as an important contributing factor to CRC disparities. OBJECTIVE To evaluate the distribution of publications across the CRC care continuum, examine interventional studies related to CRC Surgery, and synthesize findings in studies evaluating CRC disparities in Surgery. DATA SOURCES We searched PubMed for prospective or retrospective studies reporting data on colorectal cancer disparities. STUDY SELECTION Studies were selected if: (1) articles used US-sourced data (2) articles were published in the English language (3) Subjects included humans only or data. MAIN OUTCOMES AND MEASURES Odds ratios for receipt of surgery for black vs. white patients were pooled from studies that performed multivariate analysis. Subgroup analysis was performed per procedure type. RESULTS No publications regarding interventions associated with improvements in colorectal cancer surgery were found. Of the 1600 articles identified, an analysis was conducted from 18 publications. It included 89,214 black patients and 646,990 white patients. Black patients were significantly less likely to receive surgical treatment for CRC than white patients. This was confirmed in the sensitivity analysis by cancer site (colon vs rectum). CONCLUSIONS AND RELEVANCE Based on the results, the majority of studies on CRC disparities have focused on access to prevention, diagnosis and screening. Considering the impact of varying surgical outcomes on vulnerable populations, it should be considered to shift research focus from process-oriented interventions to outcomes.

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Racial/ethnic disparities in colorectal cancer treatment utilization and phase-specific costs, 2000-2014

Cited by 46 publications

References 61 publications

Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States

Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States

An Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients

Colorectal Cancer Disparities Across the Continuum of Cancer Care: A Systematic Review and Meta-Analysis

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