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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

dc.contributor.authorHao, Scarlett
dc.contributor.authorSnyder, Rebecca A.
dc.contributor.authorIrish, William
dc.contributor.authorParikh, Alexander A.
dc.date.accessioned2021-11-11T14:47:04Z
dc.date.available2021-11-11T14:47:04Z
dc.date.issued2021-10-25
dc.description.abstractBackground 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. Study setting Retrospective cohort review of a prospective hospital-based database. Methods and findings 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. Conclusions 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.en_US
dc.description.sponsorshipECU ALS PLOS Institutional Account Programen_US
dc.identifier.citationHao S, Snyder RA, Irish W, Parikh AA (2021) Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States. PLoS Med 18(10): e1003842. https://doi.org/10.1371/journal.pmed.1003842en_US
dc.identifier.urihttp://hdl.handle.net/10342/9461
dc.relation.urihttps://doi.org/10.1371/journal.pmed.1003842en_US
dc.subjectHealth insuranceen_US
dc.subjectHispanic peopleen_US
dc.subjectAdjuvant chemotherapyen_US
dc.subjectSurgical resectionen_US
dc.subjectCancers and neoplasmsen_US
dc.subjectSurgical and invasive medical proceduresen_US
dc.subjectMedicareen_US
dc.subjectChemotherapyen_US
dc.titleAssociation of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United Statesen_US
dc.typeArticleen_US
ecu.journal.issue10en_US
ecu.journal.namePLoS Medicineen_US
ecu.journal.pagese1003842en_US
ecu.journal.volume18en_US

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