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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Article info
Publication history
Published online: February 04, 2013
Received in revised form:
August 16,
2012
Received:
June 11,
2012
Footnotes
Dr. Pawlik was supported in part by the Jill Williams Memorial Research Fund.
Dr. Haider was supported by the National Institutes of Health/ NIGMS K23GM093112-01 and American College of Surgeons C. James Carrico Fellowship for the Study of Trauma and Critical Care.
Sponsoring agencies had no involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
