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.
机构:
H Lee Moffitt Canc Ctr & Res Inst, Dept Hematol & Oncol, Tampa, FL USA
Ohio State Univ, Div Med Oncol, Coll Med, Columbus, OH USAH Lee Moffitt Canc Ctr & Res Inst, Dept Hematol & Oncol, Tampa, FL USA
Meng, Lingbin
Thapa, Ram
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H Lee Moffitt Canc Ctr & Coll Med, Dept Biostat & Bioinformat, Tampa, FL USAH Lee Moffitt Canc Ctr & Res Inst, Dept Hematol & Oncol, Tampa, FL USA
Thapa, Ram
Delgado, Maria G.
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H Lee Moffitt Canc Ctr & Res Inst, Dept Canc Epidemiol, Tampa, FL USAH Lee Moffitt Canc Ctr & Res Inst, Dept Hematol & Oncol, Tampa, FL USA
Delgado, Maria G.
Gomez, Maria F.
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H Lee Moffitt Canc Ctr & Res Inst, Dept Canc Epidemiol, Tampa, FL USAH Lee Moffitt Canc Ctr & Res Inst, Dept Hematol & Oncol, Tampa, FL USA
Gomez, Maria F.
Ji, Rui
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h-index: 0
机构:
Ohio State Univ, Div Med Oncol, Coll Med, Columbus, OH USAH Lee Moffitt Canc Ctr & Res Inst, Dept Hematol & Oncol, Tampa, FL USA
Ji, Rui
Knepper, Todd C.
论文数: 0引用数: 0
h-index: 0
机构:
H Lee Moffitt Canc Ctr & Res Inst, Dept Personalized Canc Med, Tampa, FL USAH Lee Moffitt Canc Ctr & Res Inst, Dept Hematol & Oncol, Tampa, FL USA
Knepper, Todd C.
Hubbard, Joleen M.
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Mayo Clin, Div Med Oncol, Rochester, MN USAH Lee Moffitt Canc Ctr & Res Inst, Dept Hematol & Oncol, Tampa, FL USA
Hubbard, Joleen M.
Wang, Xuefeng
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H Lee Moffitt Canc Ctr & Coll Med, Dept Biostat & Bioinformat, Tampa, FL USAH Lee Moffitt Canc Ctr & Res Inst, Dept Hematol & Oncol, Tampa, FL USA
Wang, Xuefeng
Permuth, Jennifer B.
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H Lee Moffitt Canc Ctr & Res Inst, Dept Canc Epidemiol, Tampa, FL USA
H Lee Moffitt Canc Ctr & Res Inst, Dept Gastrointestinal Oncol, Tampa, FL USAH Lee Moffitt Canc Ctr & Res Inst, Dept Hematol & Oncol, Tampa, FL USA
Permuth, Jennifer B.
Kim, Richard D.
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H Lee Moffitt Canc Ctr & Res Inst, Dept Gastrointestinal Oncol, Tampa, FL USAH Lee Moffitt Canc Ctr & Res Inst, Dept Hematol & Oncol, Tampa, FL USA
Kim, Richard D.
Laber, Damian A.
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H Lee Moffitt Canc Ctr & Res Inst, Dept Hematol & Oncol, Tampa, FL USAH Lee Moffitt Canc Ctr & Res Inst, Dept Hematol & Oncol, Tampa, FL USA
Laber, Damian A.
Xie, Hao
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机构:
Mayo Clin, Div Med Oncol, Rochester, MN USA
H Lee Moffitt Canc Ctr & Res Inst, Dept Gastrointestinal Oncol, Tampa, FL USAH Lee Moffitt Canc Ctr & Res Inst, Dept Hematol & Oncol, Tampa, FL USA
机构:
Univ Calif San Francisco, Sch Med, Dept Med, San Francisco, CA USAMayo Clin, Sch Med, Rochester, MN USA
Venook, Alan P.
Mayer, Robert J.
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机构:
Dana Farber Canc Inst, Dept Med Oncol, Boston, MA 02115 USA
Harvard Med Sch, Boston, MA 02115 USAMayo Clin, Sch Med, Rochester, MN USA
Mayer, Robert J.
Fuchs, Charles S.
论文数: 0引用数: 0
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Yale Canc Ctr, New Haven, CT USA
Smilow Canc Hosp, New Haven, CT USAMayo Clin, Sch Med, Rochester, MN USA
Fuchs, Charles S.
Innocenti, Federico
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Univ N Carolina, Eshelman Sch Pharm, Chapel Hill, NC 27515 USA
Univ N Carolina, Lineberger Comprehens Canc Ctr, Chapel Hill, NC 27515 USAMayo Clin, Sch Med, Rochester, MN USA
Innocenti, Federico
Nixon, Andrew B.
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Duke Univ, Med Ctr, Duke Canc Inst, Durham, NC USAMayo Clin, Sch Med, Rochester, MN USA
Nixon, Andrew B.
Goldberg, Richard M.
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West Virginia Univ, Inst Canc, Morgantown, WV 26506 USAMayo Clin, Sch Med, Rochester, MN USA
Goldberg, Richard M.
O'Reilly, Eileen M.
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Cornell Univ, Weill Cornell Med Coll, New York, NY 10021 USA
Mem Sloan Kettering Canc Ctr, 1275 York Ave, New York, NY 10021 USAMayo Clin, Sch Med, Rochester, MN USA
O'Reilly, Eileen M.
Meyerhardt, Jeffrey A.
论文数: 0引用数: 0
h-index: 0
机构:
Dana Farber Canc Inst, Dept Med Oncol, Boston, MA 02115 USA
Harvard Med Sch, Boston, MA 02115 USAMayo Clin, Sch Med, Rochester, MN USA
机构:
Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USAHarvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USA
Markt, Sarah C.
Tang, Tianyu
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机构:
Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USAHarvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USA
Tang, Tianyu
Cronin, Angel M.
论文数: 0引用数: 0
h-index: 0
机构:
Dana Farber Canc Inst, Boston, MA 02115 USA
Harvard Med Sch, Boston, MA 02115 USAHarvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USA
Cronin, Angel M.
Katz, Ingrid T.
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机构:
Harvard Med Sch, Boston, MA 02115 USA
Brigham & Womens Hosp, Dept Med, 75 Francis St, Boston, MA 02115 USA
Massachusetts Gen Hosp, Ctr Global Hlth, Boston, MA 02114 USAHarvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USA
Katz, Ingrid T.
Howitt, Brooke E.
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机构:
Harvard Med Sch, Boston, MA 02115 USA
Brigham & Womens Hosp, Dept Pathol, 75 Francis St, Boston, MA 02115 USAHarvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USA
Howitt, Brooke E.
Horowitz, Neil S.
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h-index: 0
机构:
Dana Farber Canc Inst, Boston, MA 02115 USA
Brigham & Womens Hosp, Dept Med, 75 Francis St, Boston, MA 02115 USA
Brigham & Womens Hosp, Dept Obstet & Gynecol, Div Gynecol Oncol, 75 Francis St, Boston, MA 02115 USAHarvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USA
Horowitz, Neil S.
Lee, Larissa J.
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h-index: 0
机构:
Dana Farber Canc Inst, Boston, MA 02115 USA
Harvard Med Sch, Boston, MA 02115 USA
Brigham & Womens Hosp, Dept Radiat Oncol, 75 Francis St, Boston, MA 02115 USAHarvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USA
Lee, Larissa J.
Wright, Alexi A.
论文数: 0引用数: 0
h-index: 0
机构:
Dana Farber Canc Inst, Boston, MA 02115 USA
Harvard Med Sch, Boston, MA 02115 USA
Brigham & Womens Hosp, Dept Med, 75 Francis St, Boston, MA 02115 USAHarvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USA