title: Colon cancer lymph node evaluation among military health system beneficiaries: an analysis by race/ethnicity.
abstract: BACKGROUND
  The number of lymph nodes examined during colon cancer surgery falls below nationally recommended guidelines in the general population, with Blacks and Hispanics less likely to have adequate nodal evaluation in comparison to Whites. The Department of Defense's (DoD) Military Health System (MHS) provides equal access to medical care for its beneficiaries, regardless of racial/ethnic background. This study aimed to investigate whether racial/ethnic treatment differences exist in the MHS, an equal-access medical care system.
  
  
  METHODS
  Linked data from the DoD cancer registry and administrative claims databases were used and included 2,155 colon cancer cases. Multivariate logistic regression assessed the association between race/ethnicity and the number of lymph nodes examined (<12 and ≥12) overall and for stratified analyses.
  
  
  RESULTS
  No overall racial/ethnic differences in the number of lymph nodes examined was identified. Further stratified analyses yielded similar results, except potential racial/ethnic differences were found among persons with poorly differentiated tumors, where non-Hispanic Blacks tended to be less likely to have ≥12 lymph nodes dissected (odds ratio 0.34; 95 % confidence interval 0.14-0.80; p = 0.01) compared with non-Hispanic Whites.
  
  
  CONCLUSIONS
  Racial/ethnic disparities in the number of lymph nodes evaluated among patients with colon cancer were not apparent in an equal-access healthcare system. However, among poorly differentiated tumors there might be racial/ethnic differences in nodal yield, suggesting the possible effects of factors other than access to healthcare.
authors: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors: Abegail A
authors: AA
authors: Gill
authors: Shelia H
authors: SH
authors: Zahm
authors: Craig D
authors: CD
authors: Shriver
authors: Alexander
authors: A
authors: Stojadinovic
authors: Katherine A
authors: KA
authors: McGlynn
authors: Kangmin
authors: K
authors: Zhu
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology / Q000473:pathology*; D000328:Adult; D000368:Aged; D044383:Black People / Q000706:statistics & numerical data; D003110:Colonic Neoplasms / Q000208:ethnology / Q000473:pathology*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D044469:Racial Groups; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult