Missed opportunities: racial and neighborhood socioeconomic disparities in emergency colorectal cancer diagnosis and surgery

BMC Cancer

Sandi L Pruitt⁵  Nicholas O Davidson⁴  Samir Gupta¹  Yan Yan³  Mario Schootman² 

[1] Department of Veterans Affairs, San Diego Healthcare System, San Diego, CA, USA

[2] College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA

[3] Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO, USA

[4] Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA

[5] Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA

关键词: SEER-Medicare;    Socioeconomic status;    Race;    Disparities;    Emergency outcomes;    Colorectal cancer;   

Others  :  1117922
DOI  :  10.1186/1471-2407-14-927

 received in 2013-09-26, accepted in 2014-11-26,  发布年份 2014

【 摘 要 】

Background

Disparities by race and neighborhood socioeconomic status exist for many colorectal cancer (CRC) outcomes, including screening use and mortality. We used population-based data to determine if disparities also exist for emergency CRC diagnosis and surgery.

Methods

We examined two emergency CRC outcomes using 1992–2005 population-based U.S. SEER-Medicare data. Among CRC patients aged ≥66 years, we examined racial (African American vs. white) and neighborhood poverty disparities in two emergency outcomes defined as: 1) newly diagnosed CRC or 2) CRC surgery associated with: obstruction, perforation, or emergency inpatient admission. Multilevel logistic regression (patients nested in census tracts) analyses adjusted for sociodemographic, tumor, and clinical covariates.

Results

Of 83,330 CRC patients, 29.1% were diagnosed emergently. Of 55,046 undergoing surgery, 26.0% had emergency surgery. For both outcomes, race and neighborhood poverty disparities were evident. A significant race by poverty interaction (p < .001) was noted: poverty rate was associated with both outcomes among African Americans, but not whites. Compared to whites in low poverty (<10%) neighborhoods, African Americans in high poverty (≥20%) neighborhoods had increased odds of emergency diagnosis (AOR: 1.50, 95% CI: 1.38-1.63) and surgery (AOR: 1.63, 95% CI: 1.47-1.81).

Conclusions

Emergency CRC outcomes are associated with high poverty residence among African Americans in this population-based study, potentially contributing to observed disparities in CRC morbidity and mortality. Targeted efforts to increase CRC screening among African Americans living in high poverty neighborhoods could reduce preventable disparities.

【 授权许可】

   
2014 Pruitt et al.; licensee BioMed Central.

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