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Race, Age, Gender, and Insurance Status: A Comparative Analysis of Access to and Quality of Gastrointestinal Cancer Care

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Socioeconomics, demographics, and insurance status play roles in healthcare access. Considering the limited resources available, understanding the relative impact of disparities helps prioritize programs designed to overcome them. This study evaluates gastrointestinal cancer care disparity by comparing the impact of different patient factors across oncologic care metrices.

Methods

A multi-institutional prospectively maintained cancer database was reviewed retrospectively for gastrointestinal cancers (esophagus, stomach, liver, pancreas, colorectal, and hepato-pancreato-biliary) from 2007 to 2017 to assess quality of care provided. Quality of care was defined by clinical course following national guidelines for the respective cancer. This included surgical intervention, chemotherapy, palliative care, and minimal delay to treatment/diagnosis. Logistic regression was used to adjust for confounders and identify factors associated with quality of care. Kaplan-Meier survival curves were compared using log-rank test.

Results

One thousand seventy-two patients were identified. Survival improved in patients with private insurance compared to government-funded options [median overall survival (mOS) 57.8 vs. 21.2 months; P < .001]. Private insurance also correlated with earlier stage at diagnosis [stages I–II = 50.9% vs. 37.5%, stages III–IV = 37.7% vs. 49.1%, P < .001], increased chemotherapy use [44.2% vs. 37.1%, P < .001], and more surgical intervention [62.4% vs. 48.8%, P < .001]. Outcomes were inferior for Black Americans, including trend towards lower rate of surgical treatment [42% vs. 54%, P = .058] and worse survival in private insurance carriers [mOS 7.8 vs. 57.8 months, P = .021] and those with early stage disease [mOS 39.2 vs. 81.5 months, P = .045] compared to White counterparts.

Conclusions

Insurance status has the strongest impact on the quality of gastrointestinal oncologic care with negative synergistic negative effect of race for Black Americans. While governmental programs aim to improve equality of care, there remains significant disparity compared to private insurance. Moreover, private insurance doesn’t correct disparity for Black Americans, suggesting the need to address racial imbalances in cancer care.

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Acknowledgements

No funding was received for this research; no further acknowledgements.

Funding

This research did not receive any specific funding from agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, St. Elizabeth’s Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA

    Omid Salehi, Eduardo A. Vega, Daria James & Claudius Conrad

  2. Dana Farber Cancer Institute, Harvard School of Medicine, Boston, MA, USA

    Christopher Lathan, Olga Kozyreva & Sylvia V. Alarcon

  3. Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA

    Onur C. Kutlu

  4. Department of Radiation Oncology, St. Elizabeth’s Medical Center, & University of Massachusetts School of Medicine, Boston, MA, USA

    Beth Herrick

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  1. Omid Salehi
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Contributions

Omid Salehi, MD: conception/design of the work, data collection/acquisition, data analysis/interpretation, drafting article, revision of article, final approval

Eduardo A. Vega, MD: conception/design of the work, data collection, data analysis/interpretation, revision of article, final approval

Christopher Lathan, MD: conception/design of the work, revision of article, final approval

Daria James, CTR: data acquisition, revision of article, final approval

Olga Kozyreva, MD: conception/design of the work, data acquisition, revision of article, final approval

Sylvia V. Alarcon, MD: conception/design of the work, revision of article, final approval

Onur C. Kutlu, MD: data analysis/interpretation, revision of article, final approval

Beth Herrick, MD: conception/design of the work, revision of article, final approval

Claudius Conrad, MD, PhD: conception/design of the work, supervision/leadership, data analysis/interpretation, revision of article, final approval

Corresponding author

Correspondence to Claudius Conrad.

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Previous Presentation Acceptance: SSAT DDW (Society for Surgery of the Alimentary Tract: Digestive Disease Week) 2021, SSAT Quick Shot Session: Hepatobiliary & Pancreas I; May 21-23, 2021.

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Salehi, O., Vega, E.A., Lathan, C. et al. Race, Age, Gender, and Insurance Status: A Comparative Analysis of Access to and Quality of Gastrointestinal Cancer Care. J Gastrointest Surg 25, 2152–2162 (2021). https://doi.org/10.1007/s11605-021-05038-6

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