Rachel B Issaka1,2,3, Li Li4, Catherine Fedorenko4, Cynthia W Ko5, John M Inadomi5, Scott D Ramsey4. 1. Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA. rissaka@fredhutch.org. 2. Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA. rissaka@fredhutch.org. 3. Division of Gastroenterology, University of Washington School of Medicine, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA. rissaka@fredhutch.org. 4. Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA. 5. Division of Gastroenterology, University of Washington School of Medicine, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA.
Abstract
INTRODUCTION: In Western Washington (WA), colorectal cancer (CRC) mortality between 2012 and 2016 was highest in American Indian/Alaska Natives (AI/AN) and African-Americans (AA) at 20.7 and 18.7, respectively, compared with non-Hispanic Whites at 14.1/100,000 people. We hypothesized that time from billed encounters for CRC-associated symptoms to endoscopy completion or CRC stage at diagnosis contributed to observed differences. METHODS: Using administrative insurance claims linked to WA cancer registry data, we performed a retrospective cohort study of patients diagnosed with CRC between 2011 and 2017, with continuous insurance for 15 months prior to diagnosis and a billed encounter for CRC-associated symptoms. We determined the wait-time (days) and stage at diagnosis and conducted logistic regression analysis to identify the factors associated with endoscopy completion. RESULTS: Of the 3461 CRC patients identified, 57% had stage 2 or 3 disease with no differences in stage by race, and 84% completed an endoscopy after a billed encounter for CRC-associated symptoms. The median wait-time to endoscopy was 52 days (IQR 14-218) without differences by race. Compared with patients diagnosed with stage 1 CRC, patients with stage 4 CRC were more likely to complete an endoscopy within the first quartile of time (22.2% vs. 17.4%, p < 0.01). Living arrangement, insurance type, and comorbidity, but not race, were significant factors associated with endoscopy completion. CONCLUSIONS: We found no statistically significant differences in time from billed CRC-associated symptoms to endoscopy completion or in CRC stage among AA and AI/AN compared to Whites. This suggests that other factors are more likely to contribute to observed mortality disparities.
INTRODUCTION: In Western Washington (WA), colorectal cancer (CRC) mortality between 2012 and 2016 was highest in American Indian/Alaska Natives (AI/AN) and African-Americans (AA) at 20.7 and 18.7, respectively, compared with non-Hispanic Whites at 14.1/100,000 people. We hypothesized that time from billed encounters for CRC-associated symptoms to endoscopy completion or CRC stage at diagnosis contributed to observed differences. METHODS: Using administrative insurance claims linked to WA cancer registry data, we performed a retrospective cohort study of patients diagnosed with CRC between 2011 and 2017, with continuous insurance for 15 months prior to diagnosis and a billed encounter for CRC-associated symptoms. We determined the wait-time (days) and stage at diagnosis and conducted logistic regression analysis to identify the factors associated with endoscopy completion. RESULTS: Of the 3461 CRCpatients identified, 57% had stage 2 or 3 disease with no differences in stage by race, and 84% completed an endoscopy after a billed encounter for CRC-associated symptoms. The median wait-time to endoscopy was 52 days (IQR 14-218) without differences by race. Compared with patients diagnosed with stage 1 CRC, patients with stage 4 CRC were more likely to complete an endoscopy within the first quartile of time (22.2% vs. 17.4%, p < 0.01). Living arrangement, insurance type, and comorbidity, but not race, were significant factors associated with endoscopy completion. CONCLUSIONS: We found no statistically significant differences in time from billed CRC-associated symptoms to endoscopy completion or in CRC stage among AA and AI/AN compared to Whites. This suggests that other factors are more likely to contribute to observed mortality disparities.
Entities:
Keywords:
Administrative claims; Cancer registry; Colorectal cancer; Disparities
Authors: Garth H Rauscher; Timothy P Johnson; Young Ik Cho; Jennifer A Walk Journal: Cancer Epidemiol Biomarkers Prev Date: 2008-04-01 Impact factor: 4.254
Authors: Robin Osborn; Donald Moulds; David Squires; Michelle M Doty; Chloe Anderson Journal: Health Aff (Millwood) Date: 2014-11-19 Impact factor: 6.301
Authors: Folasade P May; Beth A Glenn; Catherine M Crespi; Ninez Ponce; Brennan M R Spiegel; Roshan Bastani Journal: Cancer Epidemiol Biomarkers Prev Date: 2016-12-29 Impact factor: 4.254
Authors: K Robin Yabroff; Ted Gansler; Richard C Wender; Kevin J Cullen; Otis W Brawley Journal: CA Cancer J Clin Date: 2019-02-20 Impact factor: 508.702
Authors: Scott V Adams; Andrea N Burnett-Hartman; Andrew Karnopp; Aasthaa Bansal; Stacey A Cohen; Victoria Warren-Mears; Scott D Ramsey Journal: Am J Prev Med Date: 2016-03-24 Impact factor: 5.043
Authors: Andrea N Burnett-Hartman; Scott V Adams; Aasthaa Bansal; Jean A McDougall; Stacey A Cohen; Andrew Karnopp; Victoria Warren-Mears; Scott D Ramsey Journal: J Health Care Poor Underserved Date: 2018
Authors: Douglas A Corley; Christopher D Jensen; Virginia P Quinn; Chyke A Doubeni; Ann G Zauber; Jeffrey K Lee; Joanne E Schottinger; Amy R Marks; Wei K Zhao; Nirupa R Ghai; Alexander T Lee; Richard Contreras; Charles P Quesenberry; Bruce H Fireman; Theodore R Levin Journal: JAMA Date: 2017-04-25 Impact factor: 56.272