A black-white comparison of the quality of stage-specific colon cancer treatment.
BACKGROUND
Several studies have attributed racial disparities in cancer incidence and mortality to variances in socioeconomic status and health insurance coverage. However, an Institute of Medicine report found that blacks received lower quality care than whites after controlling for health insurance, income, and disease severity.


METHODS
To examine the effects of race on colorectal cancer outcomes within a single setting, the authors performed a retrospective cohort study that analyzed the cancer registry, billing, and medical records of 365 university hospital patients (175 blacks and 190 whites) diagnosed with stage II-IV colon cancer between 2000 and 2005. Racial differences in the quality (effectiveness and timeliness) of stage-specific colon cancer treatment (colectomy and chemotherapy) were examined after adjusting for socioeconomic status, health insurance coverage, sex, age, and marital status.


RESULTS
Blacks and whites had similar sociodemographic characteristics, tumor stage and site, quality of care, and health outcomes. Age and diagnostic stage were predictors of quality of care and mortality. Although few patients (5.8%) were uninsured, they were more likely to present at advanced stages (61.9% at stage IV) and die (76.2%) than privately insured and publicly insured patients (p = .002).


CONCLUSIONS
In a population without racial differences in socioeconomic status or insurance coverage, patients receive the same quality of care, regardless of racial distinction, and have similar health outcomes. Age, diagnostic stage, and health insurance coverage remained independently associated with mortality. Future studies of disparities in colon cancer treatment should examine sociocultural barriers to accessing appropriate care in various healthcare settings.
Berry
Jamillah
J
Prevention Research Center, Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia 30310-1495, USA. jberry@msm.edu
Caplan
Lee
L
Davis
Sharon
S
Minor
Patrick
P
Counts-Spriggs
Margaret
M
Glover
Roni
R
Ogunlade
Vickie
V
Bumpers
Kevin
K
Kauh
John
J
Brawley
Otis W
OW
Flowers
Christopher
C
D000367:Age Factors; D000368:Aged; D044383:Black People; D003110:Colonic Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000628:therapy; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012923:Social Class; D013997:Time Factors; D016896:Treatment Outcome; D044465:White People