title: Availability of Healthcare Resources and Colorectal Cancer Outcomes Among Non-Hispanic White and Non-Hispanic Black Adults.
abstract: This study aims to examine if access to healthcare, measured through the availability of medical resources at the neighborhood level, influences colorectal cancer (CRC) stage, treatment and survival using the Surveillance Epidemiology and Ends Result (SEER) dataset (November 2012), linked with the 2004 Area Resource File. A cross-sectional study was conducted to determine the association between availability of healthcare resources and CRC outcomes among non-Hispanic Black (n = 9162) and non-Hispanic White patients (n = 97,264). CRC patients were identified using the SEER*Stat program, and individual socio-demographic, clinical, and county-level healthcare access variables were obtained for each patient. Among NH-W patients, residence in counties with lower number of oncology hospitals was associated with increased odds of late stage diagnosis (OR 1.09, 95 % CI 1.04-1.14), reduced odds of receiving surgery (OR 0.83, 95 % CI 0.74-0.92) and higher hazard rates (HR 1.09, 95 % CI 1.06-1.12). There were no significant associations among NH-B patients. Increased availability of healthcare resources improves CRC outcomes among NH-W patients. However, future studies are required to better understand healthcare utilization patterns in NH-B neighborhoods, and identify other important dimensions of healthcare access such as affordability, acceptability and accommodation.
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S. RPHB Rm 210, Birmingham, AL, 35294-0022, USA. tomiakin@uab.edu.|Comprehensive Cancer Center, University of Alabama at BIrmingham, Birmingham, AL, USA. tomiakin@uab.edu.
authors.forename: Tomi
authors.identifier: http://orcid.org/0000-0002-1412-3234
authors.initials: T
authors.lastname: Akinyemiju
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S. RPHB Rm 210, Birmingham, AL, 35294-0022, USA.|Comprehensive Cancer Center, University of Alabama at BIrmingham, Birmingham, AL, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Waterbor
authors.affiliation: Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Pisu
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S. RPHB Rm 210, Birmingham, AL, 35294-0022, USA.|Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Justin Xavier
authors.initials: JX
authors.lastname: Moore
authors.affiliation: Cancer Statistics Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
authors.forename: Sean F
authors.initials: SF
authors.lastname: Altekruse
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D018426:SEER Program; D044465:White People
keywords: Cancer; Colorectal cancer; Disparities; Healthcare access; Residential area