title: Assessing short- and long-term outcomes among black vs white Medicare patients undergoing resection of colorectal cancer.
abstract: BACKGROUND
  We sought to identify differences among black and white Medicare-insured patients with colorectal cancer who underwent resection.
  
  
  METHODS
  Surveillance, Epidemiology and End Results-Medicare (SEER-Medicare) linked inpatient data from 1986 to 2005 were examined. Differences in short- and long-term outcomes among black vs white patients were investigated.
  
  
  RESULTS
  There were 125,676 (92.4%) white and 9,891 (7.6%) black patients who met the criteria. Black patients were younger (75.5 vs 77.2 years; P < .001) but had more comorbidities than did white patients (mean Charlson comorbidity index score 3.99 vs 3.87; P < .001). Black patients demonstrated greater odds of in-hospital mortality (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.30 to 1.56) and readmission within 30 days (OR, 1.26; 95% CI, 1.18 to 1.34). Comparing 1986 to 1990 vs 2001 to 2005, black patients had greater odds of 30-day readmission (OR, 1.12 vs 1.31) but reduced odds of index in-hospital mortality (OR, 1.84 vs 1.28). Black patients had worse long-term survival after colorectal surgery (hazard ratio [HR], 1.21; 95% CI, 1.17 to 1.25; P < .001).
  
  
  CONCLUSIONS
  Black patients with colorectal cancer demonstrated increased risk of mortality and readmission after controlling for age, sex, and comorbidities. Although black vs white differences in perioperative mortality decreased over time, disparities in readmission and long-term survival persisted.
authors: Department of Surgery, Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Blalock 688, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
authors: Eric B
authors: EB
authors: Schneider
authors: Adil H
authors: AH
authors: Haider
authors: Omar
authors: O
authors: Hyder
authors: Jonathan E
authors: JE
authors: Efron
authors: Anne O
authors: AO
authors: Lidor
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D005260:Female; D054624:Health Status Disparities; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D006278:Medicare; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012007:Rectum / Q000601:surgery*; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States; D044465:White People
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