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Assessing short- and long-term outcomes among black vs white Medicare patients undergoing resection of colorectal cancer

Published:February 04, 2013DOI:https://doi.org/10.1016/j.amjsurg.2012.08.005

      Abstract

      Background

      We sought to identify differences among black and white Medicare-insured patients with colorectal cancer who underwent resection.

      Methods

      Surveillance, Epidemiology and End Results–Medicare (SEER-Medicare) linked inpatient data from 1986 to 2005 were examined. Differences in short- and long-term outcomes among black vs white patients were investigated.

      Results

      There were 125,676 (92.4%) white and 9,891 (7.6%) black patients who met the criteria. Black patients were younger (75.5 vs 77.2 years; P < .001) but had more comorbidities than did white patients (mean Charlson comorbidity index score 3.99 vs 3.87; P < .001). Black patients demonstrated greater odds of in-hospital mortality (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.30 to 1.56) and readmission within 30 days (OR, 1.26; 95% CI, 1.18 to 1.34). Comparing 1986 to 1990 vs 2001 to 2005, black patients had greater odds of 30-day readmission (OR, 1.12 vs 1.31) but reduced odds of index in-hospital mortality (OR, 1.84 vs 1.28). Black patients had worse long-term survival after colorectal surgery (hazard ratio [HR], 1.21; 95% CI, 1.17 to 1.25; P < .001).

      Conclusions

      Black patients with colorectal cancer demonstrated increased risk of mortality and readmission after controlling for age, sex, and comorbidities. Although black vs white differences in perioperative mortality decreased over time, disparities in readmission and long-term survival persisted.

      Keywords

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      References

        • U.S. Cancer Statistics Working Group
        United States Cancer Statistics: 1999–2009 Incidence and Mortality Data.
        Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute, 2012 (Available at) (Accessed: March 4, 2012)
        • Polite B.N.
        • Dignam J.J.
        • Olopade O.I.
        Colorectal cancer and race: understanding the differences in outcomes between African Americans and whites.
        Med Clin North Am. 2005; 89: 771-793
        • Kirby J.B.
        • Kaneda T.
        Unhealthy and uninsured: exploring racial differences in health and health insurance coverage using a life table approach.
        Demography. 2010; 47: 1035-1051
        • Lidor A.O.
        • Gearhart S.L.
        • Wu A.W.
        • et al.
        Effect of race and insurance status on presentation, treatment, and mortality in patients undergoing surgery for diverticulitis.
        Arch Surg. 2008; 143 (discussion 1165): 1160-1165
        • Williams D.R.
        Race, socioeconomic status, and health. The added effects of racism and discrimination.
        Ann N Y Acad Sci. 1999; 896: 173-188
        • Lucas F.L.
        • Stukel T.A.
        • Morris A.M.
        • et al.
        Race and surgical mortality in the United States.
        Ann Surg. 2006; 243: 281-286
        • Agency for Healthcare Research and Quality
        2007 National Healthcare Quality Report.
        U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Rockville, MDFebruary 2008 (AHRQ Pub. No. 08–0040. Available at) (Accessed: March 4, 2012)
        • Lidor A.O.
        • Segal J.B.
        • Wu A.W.
        • et al.
        Older patients with diverticulitis have low recurrence rates and rarely need surgery.
        Surgery. 2011; 150: 146-153
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • et al.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Schneider E.B.
        • Hyder O.
        • Brooke B.S.
        • et al.
        Patient readmission and mortality after colorectal surgery for colon cancer: impact of length of stay relative to other clinical factors.
        J Am Coll Surg. 2012; 214 (discussion 398–9): 390-398
        • Marcella S.
        • Miller J.E.
        Racial differences in colorectal cancer mortality. The importance of stage and socioeconomic status.
        J Clin Epidemiol. 2001; 54: 359-366
        • Schneider E.B.
        • Haider A.
        • Sheer A.J.
        • et al.
        Differential association of race with treatment and outcomes in Medicare patients undergoing diverticulitis surgery.
        Arch Surg. 2011; 146: 1272-1276
        • Becker E.R.
        • Rahimi A.
        Disparities in race/ethnicity and gender in in-hospital mortality rates for coronary artery bypass surgery patients.
        J Natl Med Assoc. 2006; 98: 1729-1739
        • Laiyemo A.O.
        • Doubeni C.
        • Pinsky P.F.
        • et al.
        Race and colorectal cancer disparities: health-care utilization vs. different cancer susceptibilities.
        J Natl Cancer Inst. 2010; 102: 538-546
        • Rogers S.O.
        • Ray W.A.
        • Smalley W.E.
        A population-based study of survival among elderly persons diagnosed with colorectal cancer: does race matter if all are insured? (United States).
        Cancer Causes Control. 2004; 15: 193-199
        • Chang D.C.
        • Handly N.
        • Abdullah F.
        • et al.
        The occurrence of potential patient safety events among trauma patients: are they random?.
        Ann Surg. 2008; 247: 327-334
        • Schneider E.B.
        • Haider A.H.
        • Lidor A.O.
        • et al.
        Global surgical package reimbursement and the acute care surgeon: a threat to optimal care.
        J Trauma. 2011; 70: 583-589
        • Hodgson D.C.
        • Fuchs C.S.
        • Ayanian J.Z.
        Impact of patient and provider characteristics on the treatment and outcomes of colorectal cancer.
        J Natl Cancer Inst. 2001; 93: 501-515
        • Crompton J.G.
        • Pollack K.M.
        • Oyetunji T.
        • et al.
        Racial disparities in motorcycle-related mortality: an analysis of the National Trauma Data Bank.
        Am J Surg. 2010; 200: 191-196
        • Greene W.R.
        • Oyetunji T.A.
        • Bowers U.
        • et al.
        Insurance status is a potent predictor of outcomes in both blunt and penetrating trauma.
        Am J Surg. 2010; 199: 554-557