Treatment Differences Between Blacks and Whites with Colorectal Cancer

J K Ball · Anne Elixhauser

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Health disparities and outcomes Healthcare Policy and Management Global Cancer Incidence and Screening

Abstract

OBJECTIVES: The authors examine interracial variations in treatment for over 20,000 patients hospitalized with colorectal cancer in a national sample of hospitals. METHODS: To reduce clinical heterogeneity that could explain differences in treatment, hospitalizations were classified into relatively homogeneous subgroups based on diagnoses indicating primary colorectal tumor, oncologic sequelae, and metastasis. Procedures were classified into clinically relevant treatment types. Multivariate techniques controlled for differences in patient demographics, insurance status, other clinical factors, and provider characteristics. RESULTS: Blacks were more likely than whites to be hospitalized with oncologic sequelae, diagnoses indicating advanced disease, which may capture the effects of unmanaged or poorly managed cancer. Inpatient mortality was equivalent only for the most severely ill. Otherwise, the odds of inpatient mortality were 59% to 98% higher for blacks than whites. Treatment, in terms of procedure type, was equivalent only for the sickest patients. Among the less severely ill, blacks were less likely than whites to receive major therapeutic procedures. CONCLUSIONS: Multiple findings suggest that blacks with colorectal cancer were hospitalized with more severe conditions and treated less aggressively than whites. In an era of health-care reform, such differences, which are net of insurance effects, may require more than universal insurance coverage to be overcome.

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References

1989Racial Inequalities in the Use of Procedures for Patients With Ischemic Heart Disease in Massachusetts 1992Racial and Community Factors Influencing Coronary Artery Bypass Graft Surgery Rates for All 1986 Medicare Patients 1989Coronary arteriography and coronary bypass survey among whites and other racial groups relative to hospital-based incidence rates for coronary artery disease: findings from NHDS.1991Interracial Access to Selected Cardiac Procedures for Patients Hospitalized with Coronary Artery Disease in New York State

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2003COMMITTEE ON UNDERSTANDING AND ELIMINATING RACIAL AND ETHNIC DISPARITIES IN HEALTH CARE 2008Major Deficit in the Number of Underrepresented Minority Academic Surgeons Persists 2017Factors That Contribute to Differences in Survival of Black vs White Patients With Colorectal Cancer 2009Ethnic Diversity Remains Scarce in Academic Plastic and Reconstructive Surgery 2007Meta‐analysis of racial disparities in survival in association with socioeconomic status among men and women with colon cancer 2003Racial differences in the treatment of colorectal cancer: a comparison of surgical and radiation therapy between Whites and Blacks 2005Social disparities across the continuum of colorectal cancer: a systematic review

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