Racial disparities in treatment for rectal cancer at minority-serving hospitals

Authors

Pamela W. Lu, Harvard Medical School, Boston, USA.
Rebecca E. Scully, Harvard Medical School, Boston, USA.
Adam C. Fields, Harvard Medical School, Boston, USA.
Vanessa M. Welten, Harvard Medical School, Boston, USA
Stuart R. Lipsitz, Harvard Medical School, Boston, MA, USA.
Quoc-Dien Trinh, Harvard Medical School, Boston, MA, USA
Adil H. Haider, Aga Khan UniversityFollow
Joel S. Weissman, Harvard Medical School, Boston, USA.
Karen M. Freund, Tufts University School of Medicine, Boston, MA, USA.
Nelya Melnitchouk, Harvard Medical School, Boston, USA

Document Type

Article

Department

General Surgery

Abstract

Background: Racial disparities exist in patients with rectal cancer with respect to both treatment and survival. Minority-serving hospitals (MSHs) provide healthcare to a disproportionately large percent of minority patients in the USA. We examined the effects of rectal cancer treatment at MSH to understand drivers of these disparities.
Methods: The NCDB was queried (2004-2015), and patients diagnosed with stage II or III rectal adenocarcinoma were identified. Racial case mix distribution was calculated at the institutional level, and MSHs were defined as those within the top decile of Black and Hispanic patients. Logistic regression was used to identify predictors of receipt of standard of care treatment. Survival was assessed using the Kaplan-Meier method, and Cox proportional hazards models were used to evaluate adjusted risk of death. Analyses were clustered by facility.
Results: A total of 68,842 patients met the inclusion criteria. Of these patients, 63,242 (91.9%) were treated at non-MSH, and 5600 (8.1%) were treated at MSH. In multivariable analysis, treatment at MSH (OR 0.70 95%CI 0.61-0.80 p < 0.001) and Black race (OR 0.75 95%CI 0.70-0.81 p < 0.001) were associated with significantly lower odds of receiving standard of care. In adjusted analysis, Black patients had a significantly higher risk of mortality (HR 1.20 95%CI 1.14-1.26 p < 0.001).
Conclusions: Treatment at MSH institutions and Black race were associated with significantly decreased odds of receipt of recommended standard therapy for locally advanced rectal adenocarcinoma. Survival was worse for Black patients compared to White patients despite adjustment for receipt of standard of care.

Comments

Volume, issue, and pagination are not provided by the author/publisher

Publication (Name of Journal)

Journal of Gastrointestinal Surgery

Recommended Citation

Lu, P. W., Scully, R. E., Fields, A. C., Welten, V. M., Lipsitz, S. R., Trinh, Q., Haider, A. H., Weissman, J. S., Freund, K. M., Melnitchouk, N. (2020). Racial disparities in treatment for rectal cancer at minority-serving hospitals. Journal of Gastrointestinal Surgery.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_gen/90