Perioperative Mortality Does Not Explain Racial Disparities in Gastrointestinal Cancer

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Abstract

Background: Racial minorities with gastrointestinal cancer suffer disproportionately poor overall and disease-specific survival. We used a nationally representative sample to examine the relationship between race/ethnicity and mortality and determine whether these disparities were observed in the perioperative period. Materials and Methods: The Nationwide Inpatient Sample (NIS) was used to examine patients undergoing surgery for cancers of the esophagus, stomach, pancreas, colon and rectum (“GI cancer”) between 2008 and 2012. Logistic regression was used to evaluate whether race/ethnicity was associated with perioperative mortality after adjusting for sociodemographic characteristics, perioperative factors and presentation (ER vs elective). Results: A total of 110,044 subjects were identified, including 75.8% Whites, 10.5% Black patients, 7.2% Hispanic patients, and 3.1% Asian/Pacific Islanders (API). Whites were generally older than minorities. In adjusted multivariable generalized linear mixed logistic models, no increase in perioperative mortality was seen for minorities. Worse outcomes were observed for those with higher Elixhauser comorbidity score (OR 6.90, CI 5.96–7.99), lower income region (OR 1.24, CI 1.10–1.40), males (OR 1.54, CI 1.42–1.68), and those without private insurance (Medicare OR 1.34, CI 1.16–1.55; Medicaid OR 1.27, CI 1.02–1.58; self-pay OR 1.64, CI 1.24–2.17). Differences in mortality were predominantly driven by comorbidities (pseudo %ΔR2 = 38.56%) and only minimally by race (pseudo %ΔR2 = 0.49%). Conclusion: Minority groups do not suffer higher rates of perioperative mortality for GI cancer surgeries after controlling for clinical and demographic factors. Future work to address cancer disparities should focus on areas in the cancer care trajectory such as cancer screening, surveillance, socioeconomic factors, and access.

Original languageEnglish (US)
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Gastrointestinal Neoplasms
Mortality
Comorbidity
Logistic Models
Neoplasms
Minority Groups
Perioperative Period
Medicaid
Esophageal Neoplasms
Rectal Neoplasms
Medicare
Insurance
Early Detection of Cancer
Hispanic Americans
Stomach Neoplasms
Inpatients
Pancreas
Colon
Demography
Survival

Keywords

  • Cancer
  • Disparities
  • Outcomes
  • Perioperative mortality
  • Socioeconomic status

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

@article{0a48c0b107a9471e86c3fa1e92ffe753,
title = "Perioperative Mortality Does Not Explain Racial Disparities in Gastrointestinal Cancer",
abstract = "Background: Racial minorities with gastrointestinal cancer suffer disproportionately poor overall and disease-specific survival. We used a nationally representative sample to examine the relationship between race/ethnicity and mortality and determine whether these disparities were observed in the perioperative period. Materials and Methods: The Nationwide Inpatient Sample (NIS) was used to examine patients undergoing surgery for cancers of the esophagus, stomach, pancreas, colon and rectum (“GI cancer”) between 2008 and 2012. Logistic regression was used to evaluate whether race/ethnicity was associated with perioperative mortality after adjusting for sociodemographic characteristics, perioperative factors and presentation (ER vs elective). Results: A total of 110,044 subjects were identified, including 75.8{\%} Whites, 10.5{\%} Black patients, 7.2{\%} Hispanic patients, and 3.1{\%} Asian/Pacific Islanders (API). Whites were generally older than minorities. In adjusted multivariable generalized linear mixed logistic models, no increase in perioperative mortality was seen for minorities. Worse outcomes were observed for those with higher Elixhauser comorbidity score (OR 6.90, CI 5.96–7.99), lower income region (OR 1.24, CI 1.10–1.40), males (OR 1.54, CI 1.42–1.68), and those without private insurance (Medicare OR 1.34, CI 1.16–1.55; Medicaid OR 1.27, CI 1.02–1.58; self-pay OR 1.64, CI 1.24–2.17). Differences in mortality were predominantly driven by comorbidities (pseudo {\%}ΔR2 = 38.56{\%}) and only minimally by race (pseudo {\%}ΔR2 = 0.49{\%}). Conclusion: Minority groups do not suffer higher rates of perioperative mortality for GI cancer surgeries after controlling for clinical and demographic factors. Future work to address cancer disparities should focus on areas in the cancer care trajectory such as cancer screening, surveillance, socioeconomic factors, and access.",
keywords = "Cancer, Disparities, Outcomes, Perioperative mortality, Socioeconomic status",
author = "J. Bliton and Peter Muscarella and Patricia Friedmann and Parides, {Michael K.} and Katia Papalezova and McAuliffe, {John C.} and Haejin In",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s11605-018-4064-7",
language = "English (US)",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",

}

TY - JOUR

T1 - Perioperative Mortality Does Not Explain Racial Disparities in Gastrointestinal Cancer

AU - Bliton, J.

AU - Muscarella, Peter

AU - Friedmann, Patricia

AU - Parides, Michael K.

AU - Papalezova, Katia

AU - McAuliffe, John C.

AU - In, Haejin

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Racial minorities with gastrointestinal cancer suffer disproportionately poor overall and disease-specific survival. We used a nationally representative sample to examine the relationship between race/ethnicity and mortality and determine whether these disparities were observed in the perioperative period. Materials and Methods: The Nationwide Inpatient Sample (NIS) was used to examine patients undergoing surgery for cancers of the esophagus, stomach, pancreas, colon and rectum (“GI cancer”) between 2008 and 2012. Logistic regression was used to evaluate whether race/ethnicity was associated with perioperative mortality after adjusting for sociodemographic characteristics, perioperative factors and presentation (ER vs elective). Results: A total of 110,044 subjects were identified, including 75.8% Whites, 10.5% Black patients, 7.2% Hispanic patients, and 3.1% Asian/Pacific Islanders (API). Whites were generally older than minorities. In adjusted multivariable generalized linear mixed logistic models, no increase in perioperative mortality was seen for minorities. Worse outcomes were observed for those with higher Elixhauser comorbidity score (OR 6.90, CI 5.96–7.99), lower income region (OR 1.24, CI 1.10–1.40), males (OR 1.54, CI 1.42–1.68), and those without private insurance (Medicare OR 1.34, CI 1.16–1.55; Medicaid OR 1.27, CI 1.02–1.58; self-pay OR 1.64, CI 1.24–2.17). Differences in mortality were predominantly driven by comorbidities (pseudo %ΔR2 = 38.56%) and only minimally by race (pseudo %ΔR2 = 0.49%). Conclusion: Minority groups do not suffer higher rates of perioperative mortality for GI cancer surgeries after controlling for clinical and demographic factors. Future work to address cancer disparities should focus on areas in the cancer care trajectory such as cancer screening, surveillance, socioeconomic factors, and access.

AB - Background: Racial minorities with gastrointestinal cancer suffer disproportionately poor overall and disease-specific survival. We used a nationally representative sample to examine the relationship between race/ethnicity and mortality and determine whether these disparities were observed in the perioperative period. Materials and Methods: The Nationwide Inpatient Sample (NIS) was used to examine patients undergoing surgery for cancers of the esophagus, stomach, pancreas, colon and rectum (“GI cancer”) between 2008 and 2012. Logistic regression was used to evaluate whether race/ethnicity was associated with perioperative mortality after adjusting for sociodemographic characteristics, perioperative factors and presentation (ER vs elective). Results: A total of 110,044 subjects were identified, including 75.8% Whites, 10.5% Black patients, 7.2% Hispanic patients, and 3.1% Asian/Pacific Islanders (API). Whites were generally older than minorities. In adjusted multivariable generalized linear mixed logistic models, no increase in perioperative mortality was seen for minorities. Worse outcomes were observed for those with higher Elixhauser comorbidity score (OR 6.90, CI 5.96–7.99), lower income region (OR 1.24, CI 1.10–1.40), males (OR 1.54, CI 1.42–1.68), and those without private insurance (Medicare OR 1.34, CI 1.16–1.55; Medicaid OR 1.27, CI 1.02–1.58; self-pay OR 1.64, CI 1.24–2.17). Differences in mortality were predominantly driven by comorbidities (pseudo %ΔR2 = 38.56%) and only minimally by race (pseudo %ΔR2 = 0.49%). Conclusion: Minority groups do not suffer higher rates of perioperative mortality for GI cancer surgeries after controlling for clinical and demographic factors. Future work to address cancer disparities should focus on areas in the cancer care trajectory such as cancer screening, surveillance, socioeconomic factors, and access.

KW - Cancer

KW - Disparities

KW - Outcomes

KW - Perioperative mortality

KW - Socioeconomic status

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