Gender and ethnic disparities in colon cancer presentation and outcomes in a US universal health care setting.
OBJECTIVE
Access to care is a pillar of U.S. healthcare reform and could potentially challenge existing ethnic and gender disparities in care. We present a snapshot of these disparities in surgical colon cancer patients in the largest public hospital in Massachusetts, a state leading in providing universal healthcare, to indicate potential changes that might result from universal care access.


METHODS
All surgical colon cancer patients at Massachusetts General Hospital (2004-2011) were included. Baseline characteristics, perioperative, and long-term outcomes were compared.


RESULTS
Among 1,071 patients, the 110 (10.3%) minority patients presented with more comorbid (mean Charlson score 0.84 vs. 0.71; P = 0.039), metastatic (21.8% vs. 14%; P = 0.026), and node-positive disease (50% vs. 38.8%; P = 0.014). Women (n = 521; 48.6%) had less screening diagnoses (overall: 17.8% vs. 22.6%; P = 0.049, screening age: 26.4% vs. 32.7%; P = 0.036) with subsequently higher rates of metastatic disease on pathology (11.3% vs. 7.1%, P = 0.02). Multivariate adjustment for baseline staging makes outcome disparities no longer statistically significant.


CONCLUSIONS
Significant gender and ethnic disparities subsist at baseline despite long-standing low-threshold healthcare access, although seemingly mitigated by enrollment into high-level care, empowering equal chances for underprivileged groups. The outcomes are also a reminder that universal healthcare will not be a panacea for the deeply rooted and dynamic causes of presentation inequalities.
Division of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Ramzi
R
Amri
Karien
K
Stronks
Liliana G
LG
Bordeianou
Patricia
P
Sylla
David L
DL
Berger
D000328:Adult; D000368:Aged; D003110:Colonic Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000601:surgery; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012727:Sex Characteristics; D016896:Treatment Outcome
colonic neoplasms; disease-free survival; health status disparities; healthcare disparities; minority health; mortality; neoplasm staging