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Racial Disparities in Treatment for Rectal Cancer at Minority-Serving Hospitals

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Racial disparities exist in patients with rectal cancer with respect to both treatment and survival. Minority-serving hospitals (MSHs) provide healthcare to a disproportionately large percent of minority patients in the USA. We examined the effects of rectal cancer treatment at MSH to understand drivers of these disparities.

Methods

The NCDB was queried (2004–2015), and patients diagnosed with stage II or III rectal adenocarcinoma were identified. Racial case mix distribution was calculated at the institutional level, and MSHs were defined as those within the top decile of Black and Hispanic patients. Logistic regression was used to identify predictors of receipt of standard of care treatment. Survival was assessed using the Kaplan-Meier method, and Cox proportional hazards models were used to evaluate adjusted risk of death. Analyses were clustered by facility.

Results

A total of 68,842 patients met the inclusion criteria. Of these patients, 63,242 (91.9%) were treated at non-MSH, and 5600 (8.1%) were treated at MSH. In multivariable analysis, treatment at MSH (OR 0.70 95%CI 0.61–0.80 p < 0.001) and Black race (OR 0.75 95%CI 0.70–0.81 p < 0.001) were associated with significantly lower odds of receiving standard of care. In adjusted analysis, Black patients had a significantly higher risk of mortality (HR 1.20 95%CI 1.14–1.26 p < 0.001).

Conclusions

Treatment at MSH institutions and Black race were associated with significantly decreased odds of receipt of recommended standard therapy for locally advanced rectal adenocarcinoma. Survival was worse for Black patients compared to White patients despite adjustment for receipt of standard of care.

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Authors and Affiliations

  1. Division of Gastrointestinal and General Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Pamela W. Lu, Rebecca E. Scully, Adam C. Fields, Vanessa M. Welten & Nelya Melnitchouk

  2. Center for Surgery and Public Health, Brigham and Woman’s Hospital, Harvard Medical School, 1620 Tremont St., Boston, MA, 02120, USA

    Pamela W. Lu, Stuart R. Lipsitz, Quoc-Dien Trinh, Adil Haider, Joel S. Weissman & Nelya Melnitchouk

  3. Division of Urologic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Quoc-Dien Trinh

  4. Medical College, Aga Khan University, Karachi, Pakistan

    Adil Haider

  5. Department of Medicine, Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA

    Karen M. Freund

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  1. Pamela W. Lu
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Correspondence to Pamela W. Lu or Nelya Melnitchouk.

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Conflict of Interest

QDT receives honoraria from Astellas, Bayer, Intuitive Surgical, and InsighTec. All the other authors declare no conflicts.

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This study was presented as a podium presentation at the 14th annual Academic Surgical Congress, held February 5-7, 2019 in Houston, TX.

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Lu, P.W., Scully, R.E., Fields, A.C. et al. Racial Disparities in Treatment for Rectal Cancer at Minority-Serving Hospitals. J Gastrointest Surg 25, 1847–1856 (2021). https://doi.org/10.1007/s11605-020-04744-x

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  • DOI: https://doi.org/10.1007/s11605-020-04744-x

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