Race/ethnicity and socio-economic differences in colorectal cancer surgery outcomes: analysis of the nationwide inpatient sample

BMC Cancer

Research Article

Qingrui Meng¹  Tomi Akinyemiju²  Neomi Vin-Raviv³ 

[1] Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, 35294-0022, Birmingham, AL, USA;Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, 35294-0022, Birmingham, AL, USA;Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA;University of Northern Colorado Cancer Rehabilitation Institute, Greeley, Colorado, USA;School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado, USA;

关键词: Colorectal Cancer;    Black Patient;    White Patient;    Nationwide Inpatient Sample;    Insurance Type;   

DOI  :  10.1186/s12885-016-2738-7

 received in 2015-11-22, accepted in 2016-08-21,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundThe purpose of this study was to examine racial and socio-economic differences in the receipt of laparoscopic or open surgery among patients with colorectal cancer, and to determine if racial and socio-economic differences exist in post-surgical complications, in-hospital mortality and hospital length of stay among patients who received surgery.MethodsWe conducted a cross-sectional analysis of hospitalized patients with a primary diagnosis of colorectal cancer between 2007 and 2011 using data from Nationwide Inpatient Sample. ICD-9 codes were used to capture primary diagnosis, surgical procedures, and health outcomes during hospitalization. We used logistic regression analysis to determine racial and socio-economic predictors of surgery type, post-surgical complications and mortality, and linear regression analysis to assess hospital length of stay.ResultsA total of 122,631 patients were admitted with a primary diagnosis of malignant colorectal cancer between 2007 and 2011. Of these, 17,327 (14.13 %) had laparoscopic surgery, 70,328 (57.35 %) received open surgery, while 34976 (28.52 %) did not receive any surgery. Black (36 %) and Hispanic (34 %) patients were more likely to receive no surgery compared with Whites (27 %) patients. However, among patients that received any surgery, there were no racial differences in which surgery was received (laparoscopic versus open, p = 0.2122), although socio-economic differences remained, with patients from lower residential income areas significantly less likely to receive laparoscopic surgery compared with patients from higher residential income areas (OR: 0.74, 95 % CI: 0.70-0.78). Among patients who received any surgery, Black patients (OR = 1.07, 95 % CI: 1.01-1.13), and patients with Medicare (OR = 1.16, 95 % CI: 1.11-1.22) and Medicaid (OR = 1.15, 95 % CI: 1.07-1.25) insurance experienced significantly higher post-surgical complications, in-hospital mortality (Black OR = 1.18, 95 % CI: 1.00-1.39), and longer hospital stay (Black β = 1.33, 95 % CI: 1.16-1.50) compared with White patients or patients with private insurance.ConclusionRacial and socio-economic differences were observed in the receipt of surgery and surgical outcomes among hospitalized patients with malignant colorectal cancer in the US.

【 授权许可】

CC BY   
© The Author(s). 2016