Michael Darden1, Geoffrey Parker2, Dominique Monlezun3, Edward Anderson4, Joseph F Buell5. 1. Carey Business School, Johns Hopkins University, Baltimore, MD, USA. 2. Thayer School of Engineering, Dartmouth College, Hanover, NH, USA. 3. University of Texas Health Science Center, Houston, TX, USA. 4. University of Texas McCombs Healthcare Innovation Initiative, Austin, TX, USA. 5. Department of Surgery, Mission Health, HCA North Carolina Division, University of North Carolina, Asheville, NC, USA. Joseph.buell@HCAhealthcare.com.
Abstract
BACKGROUND: The existence of race and gender disparity has been described in numerous areas of medicine. The management of hepatocellular cancer is no different, but in no other area of medicine, is the treatment algorithm more complicated by local, regional, and national health care distribution policy. METHODS: Multivariate logistic regression and Cox-regression were utilized to analyze the treatment of patients with hepatocellular cancer registered in SEER between 1999 and 2013 to determine the incidence and effects of racial and gender disparity. Odd ratios (OR) are relative to Caucasian males, SEER region, and tumor characteristics. RESULTS: The analysis of 57,449 patients identified the minority were female (25.31%) and African-American (16.26%). All tumor interventions were protective (p < 0.001) with respect to survival. The mean survival for all registered patients was 13.01 months with conditional analysis, confirming that African-American men were less likely to undergo ablation, resection, or transplantation (p < 0.001). Women were more likely to undergo resection (p < 0.001). African-American women had an equivalent OR for resection but had a significantly lower transplant rate (p < 0.001). CONCLUSIONS: Utilizing SEER data as a surrogate for patient navigation in the treatment of hepatocellular cancer, our study identified not only race but gender bias with African-American women suffering the greatest. This is underscored by the lack of navigation of African-Americans to any therapy and a significant bias to navigate female patients to resection potentially limiting subsequent access to definitive therapy namely transplantation.
BACKGROUND: The existence of race and gender disparity has been described in numerous areas of medicine. The management of hepatocellular cancer is no different, but in no other area of medicine, is the treatment algorithm more complicated by local, regional, and national health care distribution policy. METHODS: Multivariate logistic regression and Cox-regression were utilized to analyze the treatment of patients with hepatocellular cancer registered in SEER between 1999 and 2013 to determine the incidence and effects of racial and gender disparity. Odd ratios (OR) are relative to Caucasian males, SEER region, and tumor characteristics. RESULTS: The analysis of 57,449 patients identified the minority were female (25.31%) and African-American (16.26%). All tumor interventions were protective (p < 0.001) with respect to survival. The mean survival for all registered patients was 13.01 months with conditional analysis, confirming that African-American men were less likely to undergo ablation, resection, or transplantation (p < 0.001). Women were more likely to undergo resection (p < 0.001). African-American women had an equivalent OR for resection but had a significantly lower transplant rate (p < 0.001). CONCLUSIONS: Utilizing SEER data as a surrogate for patient navigation in the treatment of hepatocellular cancer, our study identified not only race but gender bias with African-American women suffering the greatest. This is underscored by the lack of navigation of African-Americans to any therapy and a significant bias to navigate female patients to resection potentially limiting subsequent access to definitive therapy namely transplantation.
Authors: Susan M Goodman; Bella Mehta; Meng Zhang; Jaqueline Szymonifka; Joseph T Nguyen; Lily Lee; Mark P Figgie; Michael L Parks; Shirin A Dey; Daisy Crego; Linda A Russell; Lisa A Mandl; Anne R Bass Journal: J Am Acad Orthop Surg Date: 2018-11-01 Impact factor: 3.020
Authors: A Schlegel; M Linecker; P Kron; G Györi; M L De Oliveira; B Müllhaupt; P-A Clavien; P Dutkowski Journal: Am J Transplant Date: 2016-11-14 Impact factor: 8.086