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Racial Disparities in Rates of Surgery for Esophageal Cancer: a Study from the National Cancer Database.
Savitch, Samantha L; Grenda, Tyler R; Scott, Walter; Cowan, Scott W; Posey, James; Mitchell, Edith P; Cohen, Steven J; Yeo, Charles J; Evans, Nathaniel R.
Afiliación
  • Savitch SL; Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. sls034@jefferson.edu.
  • Grenda TR; Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
  • Scott W; Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
  • Cowan SW; Division of Thoracic Surgery, Abington Jefferson Health, Abington, PA, USA.
  • Posey J; Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
  • Mitchell EP; Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
  • Cohen SJ; Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
  • Yeo CJ; Department of Medical Oncology & Hematology, Abington Jefferson Health, Abington, PA, USA.
  • Evans NR; Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
J Gastrointest Surg ; 25(3): 581-592, 2021 03.
Article en En | MEDLINE | ID: mdl-32500418
BACKGROUND: Treatment guidelines for stage I-III esophageal cancer indicate that management should include surgery in appropriate patients. Variations in utilization of surgery may contribute to racial differences observed in survival. We sought to identify factors associated with racial disparities in surgical resection of esophageal cancer and evaluate associated survival differences. METHODS: Patients diagnosed with stage I-III esophageal cancer from 2004 to 2015 were identified using the National Cancer Database. Matched patient cohorts were created to reduce confounding. Multivariate logistic regression was used to identify factors associated with receipt of surgery. Multi-level modeling was performed to control for random effects of individual hospitals on surgical utilization. RESULTS: A total of 60,041 patients were included (4402 black; 55,639 white). After 1:1 matching, there were 5858 patients evenly distributed across race. For all stages, significantly fewer black than white patients received surgery. Black race independently conferred lower likelihood of receiving surgery in single-level multivariable analysis (OR (95% CI); stage I, 0.67 (0.48-0.94); stage II, 0.76 (0.60-0.96); stage III, 0.62 (0.50-0.76)) and after controlling for hospital random effects. Hospital-level random effects accounted for one third of the unexplained variance in receipt of surgery. Risk-adjusted 1-, 3-, and 5-year mortality was higher for patients who did not undergo surgery. CONCLUSION: Black patients with esophageal cancer are at higher risk of mortality compared to white patients. This increased risk may be influenced by decreased likelihood of receiving surgical intervention for resectable disease, in part because of between-hospital differences. Improving access to surgical care may improve disparities in esophageal cancer survival.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Esofágicas / Disparidades en Atención de Salud Tipo de estudio: Guideline / Prognostic_studies Aspecto: Determinantes_sociais_saude Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: J Gastrointest Surg Asunto de la revista: GASTROENTEROLOGIA Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Esofágicas / Disparidades en Atención de Salud Tipo de estudio: Guideline / Prognostic_studies Aspecto: Determinantes_sociais_saude Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: J Gastrointest Surg Asunto de la revista: GASTROENTEROLOGIA Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos