Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States.

<h4>Background</h4>Both health insurance status and race independently impact colon cancer (CC) care delivery and outcomes. The relative importance of these factors in explaining racial and insurance disparities is less clear, however. This study aimed to determine the association and in...

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Autores principales:	Scarlett Hao, Rebecca A Snyder, William Irish, Alexander A Parikh
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/fbbedab17be544ef969103245c0d24e5
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spelling	oai:doaj.org-article:fbbedab17be544ef969103245c0d24e52021-12-02T19:55:44ZAssociation of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States.1549-12771549-167610.1371/journal.pmed.1003842https://doaj.org/article/fbbedab17be544ef969103245c0d24e52021-10-01T00:00:00Zhttps://doi.org/10.1371/journal.pmed.1003842https://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Both health insurance status and race independently impact colon cancer (CC) care delivery and outcomes. The relative importance of these factors in explaining racial and insurance disparities is less clear, however. This study aimed to determine the association and interaction of race and insurance with CC treatment disparities.<h4>Study setting</h4>Retrospective cohort review of a prospective hospital-based database.<h4>Methods and findings</h4>In this cross-sectional study, patients diagnosed with stage I to III CC in the United States were identified from the National Cancer Database (NCDB; 2006 to 2016). Multivariable regression with generalized estimating equations (GEEs) were performed to evaluate the association of insurance and race/ethnicity with odds of receipt of surgery (stage I to III) and adjuvant chemotherapy (stage III), with an additional 2-way interaction term to evaluate for effect modification. Confounders included sex, age, median income, rurality, comorbidity, and nodes and margin status for the model for chemotherapy. Of 353,998 patients included, 73.8% (n = 261,349) were non-Hispanic White (NHW) and 11.7% (n = 41,511) were non-Hispanic Black (NHB). NHB patients were less likely to undergo resection [odds ratio (OR) 0.66, 95% confidence interval [CI] 0.61 to 0.72, p < 0.001] or to receive adjuvant chemotherapy [OR 0.83, 95% CI 0.78 to 0.87, p < 0.001] compared to NHW patients. NHB patients with private or Medicare insurance were less likely to undergo resection [OR 0.76, 95% CI 0.63 to 0.91, p = 0.004 (private insurance); OR 0.59, 95% CI 0.53 to 0.66, p < 0.001 (Medicare)] and to receive adjuvant chemotherapy [0.77, 95% CI 0.68 to 0.87, p < 0.001 (private insurance); OR 0.86, 95% CI 0.80 to 0.91, p < 0.001 (Medicare)] compared to similarly insured NHW patients. Although Hispanic patients with private and Medicare insurance were also less likely to undergo surgical resection, this was not the case with adjuvant chemotherapy. This study is mainly limited by the retrospective nature and by the variables provided in the dataset; granular details such as continuity or disruption of insurance coverage or specific chemotherapy agents or dosing cannot be assessed within NCDB.<h4>Conclusions</h4>This study suggests that racial disparities in receipt of treatment for CC persist even among patients with similar health insurance coverage and that different disparities exist for different racial/ethnic groups. Changes in health policy must therefore recognize that provision of insurance alone may not eliminate cancer treatment racial disparities.Scarlett HaoRebecca A SnyderWilliam IrishAlexander A ParikhPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 18, Iss 10, p e1003842 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Scarlett Hao Rebecca A Snyder William Irish Alexander A Parikh Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States.
description	<h4>Background</h4>Both health insurance status and race independently impact colon cancer (CC) care delivery and outcomes. The relative importance of these factors in explaining racial and insurance disparities is less clear, however. This study aimed to determine the association and interaction of race and insurance with CC treatment disparities.<h4>Study setting</h4>Retrospective cohort review of a prospective hospital-based database.<h4>Methods and findings</h4>In this cross-sectional study, patients diagnosed with stage I to III CC in the United States were identified from the National Cancer Database (NCDB; 2006 to 2016). Multivariable regression with generalized estimating equations (GEEs) were performed to evaluate the association of insurance and race/ethnicity with odds of receipt of surgery (stage I to III) and adjuvant chemotherapy (stage III), with an additional 2-way interaction term to evaluate for effect modification. Confounders included sex, age, median income, rurality, comorbidity, and nodes and margin status for the model for chemotherapy. Of 353,998 patients included, 73.8% (n = 261,349) were non-Hispanic White (NHW) and 11.7% (n = 41,511) were non-Hispanic Black (NHB). NHB patients were less likely to undergo resection [odds ratio (OR) 0.66, 95% confidence interval [CI] 0.61 to 0.72, p < 0.001] or to receive adjuvant chemotherapy [OR 0.83, 95% CI 0.78 to 0.87, p < 0.001] compared to NHW patients. NHB patients with private or Medicare insurance were less likely to undergo resection [OR 0.76, 95% CI 0.63 to 0.91, p = 0.004 (private insurance); OR 0.59, 95% CI 0.53 to 0.66, p < 0.001 (Medicare)] and to receive adjuvant chemotherapy [0.77, 95% CI 0.68 to 0.87, p < 0.001 (private insurance); OR 0.86, 95% CI 0.80 to 0.91, p < 0.001 (Medicare)] compared to similarly insured NHW patients. Although Hispanic patients with private and Medicare insurance were also less likely to undergo surgical resection, this was not the case with adjuvant chemotherapy. This study is mainly limited by the retrospective nature and by the variables provided in the dataset; granular details such as continuity or disruption of insurance coverage or specific chemotherapy agents or dosing cannot be assessed within NCDB.<h4>Conclusions</h4>This study suggests that racial disparities in receipt of treatment for CC persist even among patients with similar health insurance coverage and that different disparities exist for different racial/ethnic groups. Changes in health policy must therefore recognize that provision of insurance alone may not eliminate cancer treatment racial disparities.
format	article
author	Scarlett Hao Rebecca A Snyder William Irish Alexander A Parikh
author_facet	Scarlett Hao Rebecca A Snyder William Irish Alexander A Parikh
author_sort	Scarlett Hao
title	Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States.
title_short	Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States.
title_full	Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States.
title_fullStr	Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States.
title_full_unstemmed	Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States.
title_sort	association of race and health insurance in treatment disparities of colon cancer: a retrospective analysis utilizing a national population database in the united states.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/fbbedab17be544ef969103245c0d24e5
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Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States.

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