Disparities in Surgical Oncologic Care
non-CME
Joanna T. Swinarska, MD (she/her/hers)
Postdoctoral Research Fellow
Northwestern University Feinberg School of Medicine, United States
Disclosure information not submitted.
Joanna T. Swinarska, MD (she/her/hers)
Postdoctoral Research Fellow
Northwestern University Feinberg School of Medicine, United States
Disclosure information not submitted.
Casey Silver, MD
Research Fellow
Northwestern University
Chicago, Illinois, United States
Disclosure information not submitted.
Reiping Huang, PhD, MS
Research Assistant Professor of Surgery
Northwestern University, United States
Disclosure information not submitted.
Yue-Yang Hu, MD, MPH
Assistant Professor of Surgery
Northwestern University Feinberg School of Medicine, United States
Disclosure information not submitted.
David J. Bentrem, MD, MS
Professor of Surgery
Northwestern University Feinberg School of Medicine, United States
Disclosure information not submitted.
David D. Odell, MD, MS
Associate Professor of Surgery
Northwestern University Feinberg School of Medicine, United States
Disclosure information not submitted.
Ryan Merkow, MD, MS (he/him/his)
Assistant Professor of Surgery
Northwestern University
Chicago, Illinois, United States
Disclosure information not submitted.
Disparities in colon cancer care and outcomes with respect to race/ethnicity, socioeconomic status (SES), and insurance are well established. However, the extent to which inequalities are the result of disparities by patient factors versus variation in hospital quality is unclear. Our objectives were to compare disparities in colon cancer care delivery and outcomes at low- and high-quality hospitals.
Methods:
Patients with stage I-III colon adenocarcinoma who underwent colectomy were identified from the National Cancer Database (2004–2017). Hospital quality was defined based on two National Quality Forum metrics: adequate lymph node excision and timely administration of adjuvant chemotherapy. Hospitals in the lowest and highest compliance quartiles were compared. SES was defined using a 7-point index of income and education. Multilevel regression models were used to evaluate disparities by race/ethnicity, SES, and insurance at low- and high-quality hospitals.
Results:
Of 92,087 patients at 574 facilities, 40,044 (43.5%) were treated at 307 facilities in the lowest quality quartile, and 52,043 (56.5%) were treated at 267 facilities in the highest quality quartile. Patients that were non-Hispanic Black or Hispanic, had low SES, or had Medicaid insurance were more likely to be treated at low-quality hospitals (all p< 0.01; Table). Among low-quality hospitals, patients with low SES (vs. high SES) had decreased odds of receiving high quality care (OR 0.9, p< 0.01), but this association was not seen with race/ethnicity or insurance status. At high-quality hospitals, there was no association between quality of colon cancer care and race/ethnicity, SES, or insurance status. Five-year survival was similar between white and non-Hispanic black patients at both low- and high-quality hospitals. Survival was decreased for patients with low SES (vs. high SES) at both low- and high-quality hospitals (p < 0.01), as well as for patients with non-private insurance coverage at both low-and high-quality hospitals (p < 0.05) (Table). Patients with low SES face disparities in the quality of colon cancer care they receive at low-quality hospitals, but not at high-quality hospitals. However, disparities in 5-year survival by SES and insurance coverage exist irrespective of hospital quality. Future efforts should focus not only on improving care at low-quality hospitals, but also on identifying mechanisms and barriers leading to survival disparities.
Conclusions: Learning Objectives: