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Colon Cancer Treatment: Are There Racial Disparities in an Equal-Access Healthcare System?

Gill, Abegail A. M.P.H1; Enewold, Lindsey Ph.D.1; Zahm, Shelia H. Sc.D.2; Shriver, Craig D. M.D.3,4,5; Stojadinovic, Alexander M.D.5,6; McGlynn, Katherine A. Ph.D.7; Zhu, Kangmin M.D.1,8

doi: 10.1097/DCR.0000000000000177
Original Contributions: Colorectal/Anal Neoplasia

BACKGROUND: In the general US population, blacks and whites have been shown to undergo colon cancer treatment at disproportionate rates. Accessibility to medical care may be the most important factor influencing differences in colon cancer treatment rates among whites and blacks.

OBJECTIVE: We assessed whether racial disparities in colon cancer surgery and chemotherapy existed in an equal-access health care system. In addition, we sought to examine whether racial differences varied according to demographic and tumor characteristics.

DESIGN AND SETTING: Database research using the Department of Defense Military Health System.

PATIENTS: Patients included 2560 non-Hispanic whites (NHW) and non-Hispanic blacks (NHB) with colon cancer diagnosed from 1998 to 2007.

MAIN OUTCOME MEASURES: Logistic regression was used to assess the associations between race and the receipt of colon cancer surgery or chemotherapy while controlling for available potential confounders, both overall and stratified by age at diagnosis, sex, and tumor stage.

RESULTS: After multivariate adjustment, the odds of receiving colon cancer surgery or chemotherapy for NHBs versus NHWs were similar (OR, 0.75 [95% CI, 0.37–1.53]; OR, 0.79 [95% CI, 0.59–1.04]). In addition, no effect modifications by age at diagnosis, sex, and tumor stage were observed.

LIMITATIONS: Treatment data might not be complete for beneficiaries who also had non-Department of Defense health insurance.

CONCLUSIONS: When access to medical care is equal, racial disparities in the provision of colon cancer surgery and chemotherapy were not apparent. Thus, it is possible that the inequalities in access to care play a major role in the racial disparities seen in colon cancer treatment in the general population.

1Division of Military Epidemiology and Population Sciences, John P. Murtha Cancer Center, Walter Reed-Bethesda, Bethesda, Maryland

2Division of Cancer Epidemiology and Genetics, Office of the Director, National Cancer Institute, National Institutes of Health, Bethesda, Maryland

3John P. Murtha Cancer Center, Walter Reed-Bethesda, Bethesda, Maryland

4General Surgery Service, Walter Reed-Bethesda, Bethesda, Maryland

5Uniformed Services University of Health Sciences, Bethesda, Maryland

6Combat Wound Initiative Program, Walter Reed-Bethesda, Bethesda, Maryland

7Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland

8Department of Preventive Medicine and Biometrics, Uniformed Services University of Health Sciences, Bethesda, Maryland

Funding/Support: This work was supported by the John P. Murtha Cancer Center, Walter Reed National Military Medical Center, via the Uniformed Services University of the Health Sciences under the auspices of the Henry M. Jackson Foundation for the Advancement of Military Medicine and by the intramural research program of the National Cancer Institute. The original data linkage was supported by the United States Military Cancer Institute and Division of Cancer Epidemiology and Genetics, National Cancer Institute.

Financial Disclosure: None reported.

Poster presentation at The American Association for Cancer Research International Conference on Frontiers in Cancer Prevention Research, Anaheim, California, October 16 to 19, 2012.

Correspondence: Kangmin Zhu, Division of Military Epidemiology and Population Sciences, John P. Murtha Cancer Center, Walter Reed-Bethesda, 11300 Rockville Pike, Suite 1215, Rockville, MD 20852. E-mail: kangmin.zhu@usuhs.edu

© 2014 The American Society of Colon and Rectal Surgeons