The association of health insurance and race with treatment and survival in patients with metastatic colorectal cancer

被引:11
|
作者
Mitsakos, Anastasios T. [1 ]
Irish, William [2 ,3 ]
Parikh, Alexander A. [1 ]
Snyder, Rebecca A. [1 ,3 ]
机构
[1] East Carolina Univ, Dept Surg, Div Surg Oncol, Brody Sch Med, Greenville, NC 27858 USA
[2] East Carolina Univ, Dept Surg, Div Surg Res, Brody Sch Med, Greenville, NC 27858 USA
[3] East Carolina Univ, Dept Publ Hlth, Brody Sch Med, Greenville, NC 27858 USA
来源
PLOS ONE | 2022年 / 17卷 / 02期
关键词
RACIAL DISPARITIES; ETHNIC DISPARITIES; OUTCOMES; STAGE; IMPROVEMENT; MORTALITY;
D O I
10.1371/journal.pone.0263818
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background Black patients and underinsured patients with colorectal cancer (CRC) present with more advanced disease and experience worse outcomes. The study aim was to evaluate the interaction of health insurance status and race with treatment and survival in metastatic CRC. Materials and methods Patients diagnosed with metastatic CRC within NCDB from 2006-2016 were included. Primary outcomes included receipt of chemotherapy and 3-year all-cause mortality. Multivariable logistic regression and Cox-regression (MVR) including a two-way interaction term of race and insurance were performed to evaluate the differential association of race and insurance with receipt of chemotherapy and mortality, respectively. Results 128,031 patients were identified; 70.6% White, 14.4% Black, 5.7% Hispanic, and 9.3% Other race. Chemotherapy use was higher among White compared to Black patients. 3year mortality rate was higher for Blacks and lower for Hispanics, in comparison with White patients. By MVR, Black patients were less likely to receive chemotherapy. When stratified by insurance status, Black patients with private and Medicare insurance were less likely to receive chemotherapy than White patients. All-cause mortality was higher in Black patients and lower in Hispanic patients, and these differences persisted after controlling for insurance and receipt of chemotherapy. Conclusion Black patients and uninsured or under-insured patients with metastatic CRC are less likely to receive chemotherapy and have increased mortality. The effect of health insurance among Blacks and Whites differs, however, and improving insurance alone does not appear to fully mitigate racial disparities in treatment and outcomes.
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页数:15
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