Lindsey A Jones1, Carol Estwing Ferrans2, Blase N Polite3, Katherine C Brewer1, Ajay V Maker4, Heather A Pauls5, Garth H Rauscher6. 1. Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois, Chicago. 2. Department of Biobehavioral Health Science, College of Nursing, University of Illinois, Chicago; Institute for Health Research and Policy, University of Illinois, Chicago. 3. Department of Medical Oncology, University of Chicago Medicine, Chicago, IL. 4. Division of Surgical Oncology, Department of Surgery, University of Illinois, Chicago; Creticos Cancer Center, Advocate Illinois Masonic Medical Center, Chicago. 5. Institute for Health Research and Policy, University of Illinois, Chicago. 6. Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois, Chicago; Institute for Health Research and Policy, University of Illinois, Chicago. Electronic address: garthr@uic.edu.
Abstract
PURPOSE: We explored a potential racial disparity in clinical delay among non-Hispanic (nH) Black and White colon cancer patients and examined factors that might account for the observed disparity. METHODS: Patients aged 30-79 years with a newly diagnosed colon cancer from 2010 to 2014 (n = 386) were recruited from a diverse sample of nine public, private, and academic hospitals in and around Chicago. Prolonged clinical delay was defined as 60 days or more or 90 days or more between medical presentation (symptoms or a screen-detected lesion) and treatment initiation (surgery or chemotherapy). Multivariable logistic regression with model-based standardization was used to estimate the disparity as a difference in prevalence of prolonged delay by race. RESULTS: Prevalence of delay in excess of 60 days was 12 percentage points (95% confidence interval: 2%, 22%) higher among nH Blacks versus Whites after adjusting for age, facility, and county of residence. Travel burden (time and distance traveled from residence to facility) explained roughly one-third of the disparity (33%, P = .05), individual and area-level socioeconomic status measures explained roughly one-half (51%, P = .21), and socioeconomic measures together with travel burden explained roughly four-fifths (79%, P = .08). CONCLUSIONS: Low socioeconomic status and increased travel burden are barriers to care disproportionately experienced by nH Black colon cancer patients.
PURPOSE: We explored a potential racial disparity in clinical delay among non-Hispanic (nH) Black and White colon cancerpatients and examined factors that might account for the observed disparity. METHODS:Patients aged 30-79 years with a newly diagnosed colon cancer from 2010 to 2014 (n = 386) were recruited from a diverse sample of nine public, private, and academic hospitals in and around Chicago. Prolonged clinical delay was defined as 60 days or more or 90 days or more between medical presentation (symptoms or a screen-detected lesion) and treatment initiation (surgery or chemotherapy). Multivariable logistic regression with model-based standardization was used to estimate the disparity as a difference in prevalence of prolonged delay by race. RESULTS: Prevalence of delay in excess of 60 days was 12 percentage points (95% confidence interval: 2%, 22%) higher among nH Blacks versus Whites after adjusting for age, facility, and county of residence. Travel burden (time and distance traveled from residence to facility) explained roughly one-third of the disparity (33%, P = .05), individual and area-level socioeconomic status measures explained roughly one-half (51%, P = .21), and socioeconomic measures together with travel burden explained roughly four-fifths (79%, P = .08). CONCLUSIONS: Low socioeconomic status and increased travel burden are barriers to care disproportionately experienced by nH Black colon cancerpatients.
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