56: Combined Impact of Race, Neighborhood, and Dual Eligibility with Mortality After Cancer Surgery Among Medicare Beneficiaries

Disparities in mortality following high-risk cancer operations have been well documented. Yet, how social risk factors interact and contribute to disparities in mortality is unknown. In this study, we evaluate how mortality is associated with race, neighborhood deprivation and dual eligibility.


Methods:

Using 100% Medicare inpatient claims, we identified Medicare beneficiaries undergoing elective pancreas, lung, colon, and rectal resection for cancer between January 2016 and December 2018. Beneficiaries self-identified as Black or White, and dual enrollment (DE) was verified from Medicare data. Beneficiaries were stratified into quartiles based on their neighborhood Area Deprivation Index (ADI) score, a composite measure of housing, education, and employment, at the census tract level. Logistic regression was used to assess the association of race, dual-eligibility, and neighborhood deprivation with 30-day mortality, after risk adjustment for age, sex, comorbidities, and procedure type.


Results:

Dual-Eligible Black beneficiaries from neighborhoods with the highest levels of deprivation had the highest probability of mortality (3.6%; 95% CI 2.34%-4.98%). The difference in mortality between Black and White beneficiaries was largest for non-dual eligibles living in low levels of deprivation (2.3%; 95% CI 1.3%-3.4% vs. 1.7%;95%CI 1.5%-1.8%). Comparatively, the difference in mortality for dual-eligible beneficiaries at high deprivation levels between Black and White was smaller (3.6%; 95%CI 2.9%-4.3% vs. 3.7%; 95%CI 2.9%-4.3%%). Probability of mortality was higher for Black beneficiaries in all combinations of ADI and DE status (Figure 1).


Conclusions:

Among White and Black Medicare beneficiaries undergoing surgery for cancer living at high levels of deprivation was associated with higher mortality. Black patients had higher mortality rates regardless of neighborhood deprivation or dual eligibility status. The effect of race was more pronounced among those with more resources. These findings highlight the need to address structural racism and community level factors in quality improvement efforts in cancer surgery.