Advertisement

Racial and Socioeconomic Disparities in the Surgical Management and Outcomes of Patients with Colorectal Carcinoma

  • Ashley L. Cairns
  • Francisco Schlottmann
  • Paula D. Strassle
  • Marco Di Corpo
  • Marco G. PattiEmail author
Original Scientific Report
  • 23 Downloads

Abstract

Introduction

Colorectal cancer (CRC) is the second leading cause of cancer mortality in the USA. We aimed to determine racial and socioeconomic disparities in the surgical management and outcomes of patients with CRC in a contemporary, national cohort.

Methods

We performed a retrospective analysis of the National Inpatient Sample for the period 2009–2015. Adult patients diagnosed with CRC and who underwent colorectal resection were included. Multivariable linear and logistic regressions were used to assess the effect of race, insurance type, and household income on patient outcomes.

Results

A total of 100,515 patients were included: 72,552 (72%) had elective admissions and 27,963 (28%) underwent laparoscopic surgery. Patients with private insurance and higher household income were consistently more likely to have laparoscopic procedures, compared to other insurance types and income levels, p < 0.0001. Black patients, compared to white patients, were more likely to have postoperative complications (OR 1.23, 95% CI, 1.17, 1.29). Patients with Medicare and Medicaid, compared to private insurance, were also more likely to have postoperative complications (OR 1.30, 95% CI, 1.24, 1.37 and OR 1.40, 95% CI, 1.31, 1.50). Patients in low-household-income areas had higher rates of any complication (OR 1.11, 95% CI 1.06, 1.16).

Conclusions

The use of laparoscopic surgery in patients with CRC is strongly influenced by insurance type and household income, with Medicare, Medicaid and low-income patients being less likely to undergo laparoscopic surgery. In addition, black patients, patients with public insurance, and patients with low household income have significant worse surgical outcomes.

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest.

References

  1. 1.
    Siegel RL, Miller KD, Fedewa SA et al (2017) Colorectal cancer statistics, 2017. CA Cancer J Clin 67(3):177–193CrossRefGoogle Scholar
  2. 2.
    Chen CF, Lin YC, Tsai HL, et al (2018) Short-and long-term outcomes of laparoscopic-assisted surgery, mini-laparotomy and conventional laparotomy in patients with Stage I–III colorectal cancer. J Minim Access Surg, epub ahead of printGoogle Scholar
  3. 3.
    Shavers VL (2007) Racial/ethnic variation in the anatomic subsite location of in situ and invasive cancers of the colon. J Natl Med Assoc 99:733–748Google Scholar
  4. 4.
    Dignam JJ, Colangelo L, Tian W et al (1999) Outcomes among African–Americans and Caucasians in colon cancer adjuvant therapy trials: findings from the National Surgical Adjuvant Breast and Bowel Project. J Natl Cancer Inst 91:1933–1940CrossRefGoogle Scholar
  5. 5.
    Doubeni CA, Field TS, Buist DS et al (2007) Racial differences in tumor stage and survival for colorectal cancer in an insured population. Cancer 109:612–620CrossRefGoogle Scholar
  6. 6.
    Aarts MJ, Lemmens VE, Louwman MW et al (2010) Socioeconomic status and changing inequalities in colorectal cancer? A review of the associations with risk, treatment and outcome. Eur J Cancer 46:2681–2695CrossRefGoogle Scholar
  7. 7.
    Zhang Q, Wang Y, Hu H et al (2017) Impact of socioeconomic status on survival of colorectal cancer patients. Oncotarget 8:106121–106131Google Scholar
  8. 8.
    Jemal A, Siegel R, Ma J et al (2015) Inequalities in premature death from colorectal cancer by state. J Clin Oncol 33:829–835CrossRefGoogle Scholar
  9. 9.
    Schlottmann F, Strassle PD, Charles AG et al (2018) Esophageal cancer surgery: spontaneous centralization in the US contributed to reduce mortality without causing health disparities. Ann Surg Oncol 25(6):1580–1587CrossRefGoogle Scholar
  10. 10.
    Schlottmann F, Gaber C, Strassle PD, et al (2018) Cholecystectomy vs. cholecystostomy for the management of acute cholecystitis in elderly patients. J Gastrointest Surg, epub ahead of printGoogle Scholar
  11. 11.
    Weeks JC, Nelson H, Gelber S et al (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287(3):321–328CrossRefGoogle Scholar
  12. 12.
    Kaiser AM, Kang JC, Chan LS et al (2004) Laparoscopic-assisted vs. open colectomy for colon cancer: a prospective randomized trial. J Laparoendosc Adv Surg Tech 14(6):329–334CrossRefGoogle Scholar
  13. 13.
    Milsom JW, Bohm B, Hammerhofer KA et al (1998) A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg 187(1):46–54CrossRefGoogle Scholar
  14. 14.
    Bagshaw PF, Allardyce RA, Frampton CM et al (2012) Long-term outcomes of the Australasian randomized clinical trial comparing laparoscopic and conventional open surgical treatments for colon cancer: the Australasian Laparoscopic Colon Cancer Study trial. Ann Surg 256(6):915–919CrossRefGoogle Scholar
  15. 15.
    Soneji S, Iyer SS, Armstrong K, Asch DA (2010) Racial disparities in stage-specific colorectal cancer mortality: 1960–2005. Am J Public Health 100:1912–1916CrossRefGoogle Scholar
  16. 16.
    Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63:11–30CrossRefGoogle Scholar
  17. 17.
    Tammana VS, Laiyemo AO (2014) Colorectal cancer disparities: issues, controversies and solutions. World J Gastroenterol 20(4):869–876CrossRefGoogle Scholar
  18. 18.
    Bolen JC, Rhodes L, Powell-Griner EE et al (2000) State-specific prevalence of selected health behaviors, by race and ethnicity—behavioral risk factor surveillance system, 1997. MMWR CDC Surveill Summ 49:1–60Google Scholar
  19. 19.
    Advani AS, Atkeson B, Brown CL et al (2003) Barriers to the participation of African–American patients with cancer in clinical trials: a pilot study. Cancer 97:1499–1506CrossRefGoogle Scholar
  20. 20.
    Gregg J, Curry RH (1994) Explanatory models for cancer among African–American women at two Atlanta neighborhood health centers: the implications for a cancer screening program. Soc Sci Med 39:519–526CrossRefGoogle Scholar
  21. 21.
    Ravi P, Sood A, Schmid M et al (2015) Racial/ethnic disparities in perioperative outcomes in major procedures: results from national surgical quality improvement program. Ann Surg 262(6):955–964CrossRefGoogle Scholar
  22. 22.
    Alnasser M, Schneider EB, Gearhart SL et al (2014) National disparities in laparoscopic colorectal procedures for colon cancer. Surg Endosc 28(1):49–57CrossRefGoogle Scholar
  23. 23.
    Mehtsun WT, Figueroa JF, Zhang J et al (2017) Racial disparities in surgical mortality: the gap appears to have narrowed. Health Affairs 36(6):64CrossRefGoogle Scholar
  24. 24.
    Robbins AS, Chen AY, Stewart AK et al (2010) Insurance status and survival disparities among nonelderly rectal cancer patients in the national cancer data base. Cancer 116:4178–4186CrossRefGoogle Scholar
  25. 25.
    Robbins AS, Pavluck AL, Fedewa SA et al (2009) Insurance status, comorbidity level, and survival among colorectal cancer patients age 18 to 64 years in the national cancer data base from 2003 to 2005. J Clin Oncol 27:3627–3633CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Ashley L. Cairns
    • 1
  • Francisco Schlottmann
    • 1
    • 2
  • Paula D. Strassle
    • 2
    • 3
  • Marco Di Corpo
    • 1
  • Marco G. Patti
    • 1
  1. 1.Department of Medicine and SurgeryUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Department of SurgeryHospital Alemán of Buenos AiresBuenos AiresArgentina
  3. 3.Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA

Personalised recommendations