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Perioperative Mortality Does Not Explain Racial Disparities in Gastrointestinal Cancer

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Racial minorities with gastrointestinal cancer suffer disproportionately poor overall and disease-specific survival. We used a nationally representative sample to examine the relationship between race/ethnicity and mortality and determine whether these disparities were observed in the perioperative period.

Materials and Methods

The Nationwide Inpatient Sample (NIS) was used to examine patients undergoing surgery for cancers of the esophagus, stomach, pancreas, colon and rectum (“GI cancer”) between 2008 and 2012. Logistic regression was used to evaluate whether race/ethnicity was associated with perioperative mortality after adjusting for sociodemographic characteristics, perioperative factors and presentation (ER vs elective).

Results

A total of 110,044 subjects were identified, including 75.8% Whites, 10.5% Black patients, 7.2% Hispanic patients, and 3.1% Asian/Pacific Islanders (API). Whites were generally older than minorities. In adjusted multivariable generalized linear mixed logistic models, no increase in perioperative mortality was seen for minorities. Worse outcomes were observed for those with higher Elixhauser comorbidity score (OR 6.90, CI 5.96–7.99), lower income region (OR 1.24, CI 1.10–1.40), males (OR 1.54, CI 1.42–1.68), and those without private insurance (Medicare OR 1.34, CI 1.16–1.55; Medicaid OR 1.27, CI 1.02–1.58; self-pay OR 1.64, CI 1.24–2.17). Differences in mortality were predominantly driven by comorbidities (pseudo %ΔR2 = 38.56%) and only minimally by race (pseudo %ΔR2 = 0.49%).

Conclusion

Minority groups do not suffer higher rates of perioperative mortality for GI cancer surgeries after controlling for clinical and demographic factors. Future work to address cancer disparities should focus on areas in the cancer care trajectory such as cancer screening, surveillance, socioeconomic factors, and access.

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Authors and Affiliations

  1. Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA

    J. Bliton, P. Muscarella, P. Friedmann, M. Parides, K. Papalezova, J. C. McAuliffe & H. In

  2. Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA

    P. Friedmann & M. Parides

  3. Department of Epidemiology and Population Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA

    H. In

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  1. J. Bliton
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Contributions

Analysis and interpretation of data—JB, PF, HI, MP.

Editing and drafting of the manuscripts—All.

Conception and design of study and/or acquisition of data—JB, PF, HI.

All authors gave final approval for the manuscript to be published.

Corresponding author

Correspondence to H. In.

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The authors have no disclosures to report. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Meeting Presentation

A previous version of this project was presented at ACS Clinical Congress in San Diego, California 2017.

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Appendix

Appendix

Table 4 Procedures Included/Procedure Codes (ICD-9)
Full size table
Table 5 Model with metastatic cancer as separate variable and random effects
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Table 6 Model with separate comorbidities
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Table 7 Model with separate hospital factors
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Bliton, J., Muscarella, P., Friedmann, P. et al. Perioperative Mortality Does Not Explain Racial Disparities in Gastrointestinal Cancer. J Gastrointest Surg 23, 1631–1642 (2019). https://doi.org/10.1007/s11605-018-4064-7

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  • DOI: https://doi.org/10.1007/s11605-018-4064-7

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