BACKGROUND: Black-white disparities exist in receipt of recommended medical care, including colorectal cancer treatment. This retrospective cohort study examines the degree to which health systems (e.g., physician, hospital) factors explain black-white disparities in colon cancer care. METHODS: Data from the Surveillance, Epidemiology, and End Results program; Medicare claims; the American Medical Association Masterfile; and hospital surveys were linked to examine chemotherapy receipt after stage III colon cancer resection among 5294 elderly (> or = 66 years of age) black and white Medicare-insured patients. Logistic regression analysis was used to identify factors associated with black-white differences in chemotherapy use. All statistical tests were two-sided. RESULTS: Black and white patients were equally likely to consult with a medical oncologist, but among patients who had such a consultation, black patients were less likely than white patients (59.3% versus 70.4%, difference = 10.9%, 95% confidence interval [CI] = 5.1% to 16.4%, P < .001) to receive chemotherapy. This black-white disparity was highest among patients aged 66-70 years (black patients 65.7%, white patients 86.3%, difference = 20.6%, 95% CI = 10.7% to 30.4%, P < .001) and decreased with age. The disparity among patients aged 66-70 years also remained statistically significant in the regression analysis. Overall, patient, physician, hospital, and environmental factors accounted for approximately 50% of the disparity in chemotherapy receipt among patients aged 66-70 years; surgical length of stay and neighborhood socioeconomic status accounted for approximately 27% of the disparity in this age group, and health systems factors accounted for 12%. CONCLUSIONS: Black and white Medicare-insured colon cancer patients have an equal opportunity to learn about adjuvant chemotherapy from a medical oncologist but do not receive chemotherapy equally. Little disparity was explained by health systems; more was explained by illness severity, social support, and environment. Further qualitative research is needed to understand the factors that influence the lower receipt of chemotherapy by black patients.
BACKGROUND: Black-white disparities exist in receipt of recommended medical care, including colorectal cancer treatment. This retrospective cohort study examines the degree to which health systems (e.g., physician, hospital) factors explain black-white disparities in colon cancer care. METHODS: Data from the Surveillance, Epidemiology, and End Results program; Medicare claims; the American Medical Association Masterfile; and hospital surveys were linked to examine chemotherapy receipt after stage III colon cancer resection among 5294 elderly (> or = 66 years of age) black and white Medicare-insured patients. Logistic regression analysis was used to identify factors associated with black-white differences in chemotherapy use. All statistical tests were two-sided. RESULTS: Black and white patients were equally likely to consult with a medical oncologist, but among patients who had such a consultation, black patients were less likely than white patients (59.3% versus 70.4%, difference = 10.9%, 95% confidence interval [CI] = 5.1% to 16.4%, P < .001) to receive chemotherapy. This black-white disparity was highest among patients aged 66-70 years (black patients 65.7%, white patients 86.3%, difference = 20.6%, 95% CI = 10.7% to 30.4%, P < .001) and decreased with age. The disparity among patients aged 66-70 years also remained statistically significant in the regression analysis. Overall, patient, physician, hospital, and environmental factors accounted for approximately 50% of the disparity in chemotherapy receipt among patients aged 66-70 years; surgical length of stay and neighborhood socioeconomic status accounted for approximately 27% of the disparity in this age group, and health systems factors accounted for 12%. CONCLUSIONS: Black and white Medicare-insured colon cancerpatients have an equal opportunity to learn about adjuvant chemotherapy from a medical oncologist but do not receive chemotherapy equally. Little disparity was explained by health systems; more was explained by illness severity, social support, and environment. Further qualitative research is needed to understand the factors that influence the lower receipt of chemotherapy by black patients.
Authors: Jeanne S Mandelblatt; Jon F Kerner; Jack Hadley; Yi-Ting Hwang; Lynne Eggert; Lenora E Johnson; Karen Gold Journal: Cancer Date: 2002-10-01 Impact factor: 6.860
Authors: E P McCarthy; R B Burns; S S Coughlin; K M Freund; J Rice; S L Marwill; A Ash; M Shwartz; M A Moskowitz Journal: Ann Intern Med Date: 1998-05-01 Impact factor: 25.391
Authors: E Z Oddone; R D Horner; T Diers; J Lipscomb; L McIntyre; C Cauffman; J Whittle; L J Passman; L Kroupa; R Heaney; D Matchar Journal: J Natl Med Assoc Date: 1998-01 Impact factor: 1.798
Authors: W Demark-Wahnefried; J M Schildkraut; C E Iselin; E Conlisk; A Kavee; T E Aldrich; E J Lengerich; P J Walther; D F Paulson Journal: Cancer Date: 1998-07-15 Impact factor: 6.860
Authors: Lori A Pollack; Walter Adamache; Christie R Eheman; A Blythe Ryerson; Lisa C Richardson Journal: Health Serv Res Date: 2008-12-15 Impact factor: 3.402
Authors: Adeyinka O Laiyemo; Chyke Doubeni; Paul F Pinsky; V Paul Doria-Rose; Robert Bresalier; Lois E Lamerato; E David Crawford; Paul Kvale; Mona Fouad; Thomas Hickey; Thomas Riley; Joel Weissfeld; Robert E Schoen; Pamela M Marcus; Philip C Prorok; Christine D Berg Journal: J Natl Cancer Inst Date: 2010-03-31 Impact factor: 13.506
Authors: S Yousuf Zafar; Stewart C Alexander; Kevin P Weinfurt; Kevin A Schulman; Amy P Abernethy Journal: Support Care Cancer Date: 2008-09-19 Impact factor: 3.603
Authors: Jamillah Berry; Lee Caplan; Sharon Davis; Patrick Minor; Margaret Counts-Spriggs; Roni Glover; Vickie Ogunlade; Kevin Bumpers; John Kauh; Otis W Brawley; Christopher Flowers Journal: Cancer Date: 2010-02-01 Impact factor: 6.860
Authors: Sook Y Chan; Pasithorn A Suwanabol; Rachelle N Damle; Jennifer S Davids; Paul R Sturrock; W Brian Sweeney; Justin A Maykel; Karim Alavi Journal: J Gastrointest Surg Date: 2016-08-25 Impact factor: 3.452